A citric acid anticoagulation adjustment system for blood purification

Abstract

The application discloses a citric acid anticoagulation adjustment system for blood purification, which comprises an in-vivo free calcium detection device, an in-vitro free calcium detection device arranged on a blood purification pipeline, a citric acid injection device arranged on the blood purification pipeline and used for injecting citric acid, a calcium chloride injection device arranged on the blood purification pipeline and used for injecting calcium chloride, and a control device which respectively receives in-vivo free calcium and in-vitro free calcium detected by the in-vivo free calcium detection device and the in-vitro free calcium detection device, and controls the citric acid injection device and the calcium chloride injection device to inject required citric acid and calcium chloride in a treatment mode into the blood purification pipeline. The control device judges whether the in-vivo free calcium detection value detected by the in-vivo free calcium detection device is within a target range of in-vivo free calcium, and controls the calcium chloride injection device to supplement or not supplement calcium chloride according to a judgment result.

Description

Technical Field

[0001] This invention relates to the field of blood purification, and more particularly to a citrate anticoagulation adjustment system for blood purification. Background Technology

[0002] Citrate anticoagulation is currently the preferred anticoagulation method in the field of blood purification, especially for patients at risk of bleeding. Its advantages include local anticoagulation and no systemic side effects after metabolism, resulting in high safety. The mechanism of citrate anticoagulation is through binding with calcium ions in the blood (Ca). 2+ Citrate inhibits blood clotting by blocking the calcium-dependent step in the coagulation chain reaction. Therefore, when using citrate for anticoagulation, three aspects need attention: ① Calcium ion concentration: Calcium ions in the extracorporeal circulation tubing need to be maintained at a low level (for anticoagulation), and serum calcium needs to be kept normal (to avoid hypocalcemic tetany). ② Acid-base status: Metabolic alkalosis requires adjustment of the citrate dosage or dialysate composition. ③ Citrate accumulation: Manifested as elevated total serum calcium, decreased calcium ion concentration, and increased anion gap.

[0003] In current clinical practice, the interpretation of blood gas results still relies on doctors' past experience and consultation of relevant materials to adjust the treatment plan. For some doctors with less clinical experience in blood purification treatment, or when the patient's condition is more complicated, it is difficult to make a treatment opinion in a short period of time. Summary of the Invention

[0004] The purpose of this invention is to provide a citrate anticoagulation adjustment system for blood purification, so as to easily and quickly complete the anticoagulation operation of blood filtration treatment during blood purification treatment.

[0005] According to a first aspect of the present invention, a citrate anticoagulation adjustment system for blood purification comprises: In vivo free calcium detection device for detecting the value of free calcium in the body; An in vitro free calcium detection device installed on the blood purification tubing to detect in vitro free calcium levels; A citric acid injection device installed in the blood purification pipeline for injecting citric acid; A calcium chloride injection device installed in the blood purification pipeline for injecting calcium chloride; A control device that receives in vivo free calcium and in vitro free calcium detected by an in vivo free calcium detection device and an in vitro free calcium detection device respectively, and controls the citric acid injection device and the calcium chloride injection device to inject the citric acid and calcium chloride required for the treatment mode into the blood purification pipeline. The control device determines whether the in vivo free calcium detection value detected by the in vivo free calcium detection device is within the target range for in vivo free calcium, and controls the calcium chloride injection device to supplement or not supplement calcium chloride based on the determination result, including: If the detected value of free calcium in the body is determined to be within the target range of free calcium in the body, then the calcium chloride injection device is controlled to maintain the calcium chloride injected into the blood purification pipeline. If it is determined that the free calcium level in the body is below the target range for free calcium in the body, then the calcium chloride injection device is controlled to replenish calcium chloride into the blood purification pipeline in a single operation. If the detected value of free calcium in the body is determined to be below the second range of free calcium supplementation, which is below the first range, then the calcium chloride injection device is controlled to supplement calcium chloride into the blood purification pipeline in several batches until the free calcium range in the body returns to the target value range.

[0006] Preferably, the target range for free calcium in vivo is 1.0-1.2 mmol / L; the target range for free calcium in vitro is 0.25-0.45 mmol / L; the range for the first supplementation of free calcium in vivo is 0.8-1.0 mmol / L; the range for the second supplementation of free calcium in vivo is <0.8 mmol / L; and the amount of calcium chloride supplemented into the blood purification tubing 370 in a single or multiple doses is 9-11 ml of 5% calcium chloride.

[0007] In one example, the citrate anticoagulation adjustment system also includes a total calcium detection device installed on the blood purification tubing; when the control device determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device determines whether to stop the infusion of citrate based on the total calcium value detected by the total calcium detection device and the in vivo free calcium value detected by the in vivo free calcium detection device, including: When the total calcium value / free calcium in the body is >2.5 and the free calcium in the body is <0.8 mmol / L, the control device controls the citric acid injection device to stop injecting citric acid into the blood purification pipeline.

[0008] In another example, the citrate anticoagulation adjustment system also includes a lactate detection device for detecting lactate in the blood and an HCO3 detection device for detecting HCO3 in the blood. When the control device determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device determines whether to stop the infusion of citrate into the citrate infusion device based on the lactate value detected by the lactate detection device and the HCO3 value detected by the HCO3 detection device. This includes: when the current lactate value / previous lactate value is greater than 1 and the current HCO3 / previous HCO3 value is less than 1, the control device controls the citrate infusion device to stop injecting citrate into the blood purification pipeline.

[0009] According to a second aspect of the present invention, a citrate anticoagulation adjustment system for blood purification comprises: In vivo free calcium detection device for detecting the value of free calcium in the body; An in vitro free calcium detection device installed on the blood purification tubing to detect in vitro free calcium levels; A citric acid injection device installed in the blood purification pipeline for injecting citric acid; A sodium bicarbonate injection device installed in the blood purification tubing for injecting sodium bicarbonate; A control device that receives in vivo free calcium and in vitro free calcium detected by an in vivo free calcium detection device and an in vitro free calcium detection device respectively, and controls the citric acid injection device and the sodium bicarbonate injection device to inject the citric acid and sodium bicarbonate required for the treatment mode into the blood purification pipeline. When the control device determines that the in vivo free calcium detection value is within the target range for in vivo free calcium, it controls the citrate injection device and sodium bicarbonate injection device to adjust the injection volume of citrate and sodium bicarbonate into the blood purification tubing based on the in vitro free calcium value detected by the in vitro free calcium detection device. This includes: if the in vitro free calcium detection value is within the target range for in vitro free calcium, the control device controls the citrate injection device and sodium bicarbonate injection device to maintain the injection volume of citrate and sodium bicarbonate into the blood purification tubing; if the in vitro free calcium detection value is within the target range for in vitro free calcium, the control device controls the citrate injection device and sodium bicarbonate injection device to maintain the injection volume of citrate and sodium bicarbonate into the blood purification tubing; if the in vitro free calcium detection value is within the target range for in vivo .... If the in vitro free calcium value detected by the measuring device is greater than the target range for in vitro free calcium, the control device controls the citric acid injection device to increase the amount of citric acid injected into the blood purification pipeline by a first increase, and controls the sodium bicarbonate injection device to decrease the amount of sodium bicarbonate injected into the blood purification pipeline by a first decrease; if the in vitro free calcium value detected by the in vitro free calcium measuring device is less than the target range for in vitro free calcium, the control device controls the citric acid injection device to decrease the amount of citric acid injected into the blood purification pipeline by a second decrease, and controls the sodium bicarbonate injection device to increase the amount of sodium bicarbonate injected into the blood purification pipeline by a second increase.

[0010] Preferably, the target range for free calcium in vivo is 1.0-1.2 mmol / L; the target range for free calcium in vitro is 0.25-0.45 mmol / L; the first increase is 10 ml / h; the first decrease is 5 ml / h; the second decrease is 10-20 ml / h; and the second increase is 5-10 ml / h.

[0011] According to a third aspect of the present invention, a citrate anticoagulation adjustment system for blood purification comprises: In vivo free calcium detection device for detecting the value of free calcium in the body; An in vitro free calcium detection device installed on the blood purification tubing to detect in vitro free calcium levels; A citric acid injection device installed in the blood purification pipeline for injecting citric acid; A sodium bicarbonate injection device installed in the blood purification pipeline for injecting sodium bicarbonate; A blood flow regulating device installed on the blood purification pipeline to adjust the blood flow rate; A control device that receives in vivo free calcium and in vitro free calcium detected by an in vivo free calcium detection device and an in vitro free calcium detection device respectively, and controls the blood flow adjustment device to adjust the blood flow in the blood purification pipeline. When the control device determines that the in vivo free calcium detection value detected by the in vivo free calcium detection device is within the target range for in vivo free calcium, it controls the blood flow adjustment device to adjust the blood flow in the blood purification pipeline based on the in vitro free calcium detection value detected by the in vitro free calcium detection device, including: If the in vitro free calcium value detected by the in vitro free calcium detection device is within the target range for in vitro free calcium, the control device controls the blood flow adjustment device to maintain the blood flow in the blood purification pipeline. If the in vitro free calcium value detected by the in vitro free calcium detection device is greater than the first in vitro free calcium value within the target range of in vitro free calcium, then the control device controls the blood flow adjustment device to reduce the blood flow in the blood purification pipeline by a first reduction amount. If the in vitro free calcium value detected by the in vitro free calcium detection device is greater than the first in vitro free calcium value, the control device controls the blood flow adjustment device to reduce the blood flow in the blood purification pipeline by a second reduction amount. If the in vitro free calcium value detected by the in vitro free calcium detection device is less than the target range for in vitro free calcium, the control device controls the blood flow adjustment device to increase the blood flow in the blood purification pipeline by a first increase.

[0012] Preferably, the target range for free calcium in vivo is 1.0-1.2 mmol / L; the target range for free calcium in vitro is 0.25-0.45 mmol / L; the first reduction rate is 5 ml / min; the second reduction rate is 10-20 ml / min; and the first increase rate is 10 ml / min.

[0013] In one example, the citrate anticoagulation adjustment system also includes a total calcium detection device installed on the blood purification tubing; when the control device 200 determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device determines whether to stop the infusion of citrate by the citrate infusion device based on the total calcium value detected by the total calcium detection device and the in vivo free calcium value detected by the in vivo free calcium detection device, including: when the total calcium value / in vivo free calcium > 2.5 and the in vivo free calcium < 0.8 mmol / L, the control device controls the citrate infusion device to stop injecting citrate into the blood purification tubing.

[0014] In another example, the citrate anticoagulation adjustment system also includes a lactate detection device for detecting lactate in the blood and an HCO3 detection device for detecting HCO3 in the blood. When the control device determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device determines whether to stop the injection of citrate into the citrate infusion device based on the lactate value detected by the lactate detection device and the HCO3 value detected by the HCO3 detection device 120. This includes: when the current lactate value / previous lactate value is greater than 1 and the current HCO3 / previous HCO3 value is less than 1, the control device controls the citrate infusion device to stop injecting citrate into the blood purification pipeline.

[0015] This invention can dynamically adjust the anticoagulation regimen according to the patient's physiological state, coagulation function and treatment goals, which significantly reduces the incidence of treatment-related complications and the rate of unplanned complications, with the rate of unplanned complications remaining below 4% year after year. Attached Figure Description

[0016] Figure 1 This is a schematic diagram of the first embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention; Figure 2 This is a schematic diagram of the first embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention applied to a CRRT device; Figure 3 This is a schematic diagram of the second embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention; Figure 4 This is a schematic diagram of the second embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention applied to a CRRT device; Figure 5 This is a schematic diagram of the third embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention; Figure 6 This is a schematic diagram of the third embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention applied to a CRRT device; Figure 7 This is a schematic diagram of the fourth embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention; Figure 8 This is a schematic diagram of the fourth embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention applied to a CRRT device; Figure 9 This is a schematic diagram of the fourth embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention; Figure 10 This is a schematic diagram of the fourth embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention applied to a CRRT device. Detailed Implementation

[0017] See Figure 1 and Figure 2 A first embodiment of the citrate anticoagulation adjustment system for blood purification according to the present invention includes: an in vivo free calcium detection device 100 for detecting in vivo free calcium levels; an in vitro free calcium detection device 310 installed on a blood purification pipeline 370 for detecting in vitro free calcium levels; a citrate injection device 340 installed on the blood purification pipeline 370 for injecting citrate; a calcium chloride injection device 330 installed on the blood purification pipeline 370 for injecting calcium chloride; and a control device 200 that receives in vivo free calcium and in vitro free calcium detected by the in vivo free calcium detection device 100 and the in vitro free calcium detection device 310 respectively, and controls the citrate injection device 340 and the calcium chloride injection device 330 to inject the citrate and calcium chloride required for the treatment mode into the blood purification pipeline 370; the control device 200 determines whether the in vivo free calcium detection value detected by the in vivo free calcium detection device 100 is within the target range of in vivo free calcium, and controls the calcium chloride injection device 330 to supplement or not supplement calcium chloride according to the determination result. The calcium chloride injection device 330 is an injection device that uses a micro pump to precisely control the amount of calcium chloride injected.

[0018] The in vivo free calcium detection device 100 and the in vitro free calcium detection device 310 of the present invention are devices that use a blood gas analyzer to detect free calcium in the blood.

[0019] The control device of the present invention controls the calcium chloride injection device 330 to supplement or not supplement calcium chloride according to the judgment result, including: If it is determined that the detected value of free calcium in the body is within the target range of free calcium in the body, then the calcium chloride injection device 330 is controlled to maintain the calcium chloride injected into the blood purification pipeline 370. If it is determined that the free calcium detection value in the body is below the target range for free calcium in the body, then the calcium chloride injection device 330 is controlled to supplement calcium chloride into the blood purification pipeline 370 in a single operation. If the detected value of free calcium in the body is determined to be below the second range of free calcium supplementation, which is below the first range, then the calcium chloride injection device 330 is controlled to supplement calcium chloride into the blood purification pipeline 370 in several batches until the free calcium range in the body returns to the target value range.

[0020] The target range for free calcium in vivo in this invention is 1.0-1.2 mmol / L; the target range for free calcium in vitro is 0.25-0.45 mmol / L; the first range for free calcium supplementation in vivo is 0.8-1.0 mmol / L; the second range for free calcium supplementation in vivo is <0.8 mmol / L; and the amount of calcium chloride supplemented into the blood purification tubing 370 in a single or multiple doses is 9-11 ml of 5% calcium chloride.

[0021] The citrate anticoagulation adjustment system of the present invention also includes a total calcium detection device 320 disposed on the blood purification pipeline 370.

[0022] When the control device 200 determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium, and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device 200 needs to determine whether to stop the infusion of citric acid by the citrate infusion device 340 based on the total calcium value detected by the total calcium detection device 320 and the in vivo free calcium value detected by the in vivo free calcium detection device 100. Specifically, when the total calcium value / in vivo free calcium > 2.5 and the in vivo free calcium < 0.8 mmol / L, the control device 200 determines that citric acid has accumulated, and controls the citric acid infusion device to stop the infusion of citric acid into the blood purification tubing 370 and issues an alarm. While stopping the infusion of citric acid, the dosage of sodium bicarbonate can be appropriately increased, and the frequency of blood gas monitoring can be increased (clinically, it is generally monitored every 30 minutes to 1 hour), so that the sodium bicarbonate reaches and is maintained at a normal level.

[0023] In the first embodiment described above, the blood pump 360 does not participate in the blood flow adjustment operation in the blood purification pipeline 370.

[0024] See Figure 3 and Figure 4 A second embodiment of the citrate anticoagulation adjustment system for blood purification according to the present invention includes: an in vivo free calcium detection device 100 for detecting in vivo free calcium levels; an in vitro free calcium detection device 310 installed on the blood purification pipeline 370 for detecting in vitro free calcium levels; a lactate detection device 110 installed on the blood purification pipeline 370 for detecting in vivo lactate; an HCO3 detection device 120 installed on the blood purification pipeline 370 for detecting in vivo HCO3; a citrate injection device 340 installed on the blood purification pipeline 370 for injecting citrate; and a calcium chloride injection device installed on the blood purification pipeline 370. The system includes a calcium chloride injection device 330; a control device 200 that receives in vivo free calcium, in vitro free calcium, lactic acid, and HCO3 detected by an in vivo free calcium detection device 100, an in vitro free calcium detection device 310, a lactic acid detection device 110, and an HCO3 detection device 120, and controls the citric acid injection device 340 and the calcium chloride injection device 330 to inject the required citric acid and calcium chloride into the blood purification tubing 370 for the treatment mode; the control device 200 determines whether the in vivo free calcium detection value detected by the in vivo free calcium detection device 100 is within the target range of in vivo free calcium, and controls the calcium chloride injection device 330 to supplement or not supplement calcium chloride according to the determination result.

[0025] In a specific example, when the control device 200 determines that the detected value of free calcium in the body is within the target range of free calcium in the body, it controls the calcium chloride injection device 330 to maintain the injection of calcium chloride into the blood purification tubing 370; when the control device 200 determines that the detected value of free calcium in the body is within the first calcium supplementation range of free calcium in the body, which is lower than the target range of free calcium in the body, it controls the calcium chloride injection device 330 to supplement calcium chloride into the blood purification tubing 370 in a single injection; when the control device 200 determines that the detected value of free calcium in the body is within the second calcium supplementation range of free calcium in the body, which is lower than the first calcium supplementation range of free calcium in the body, it controls the calcium chloride injection device 330 to supplement calcium chloride into the blood purification tubing 370 in multiple injections until the range of free calcium in the body returns to the target value range.

[0026] Specifically, when the control device 200 determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device 200 determines whether to stop the citric acid injection device 340 from injecting citric acid based on the lactate value detected by the lactate detection device 110 and the HCO3 value detected by the HCO3 detection device 120. Specifically, when the current lactate value / previous lactate value > 1 and the current HCO3 / previous HCO3 < 1, the control device 200 determines that citric acid is accumulating and controls the citric acid injection device to stop injecting citric acid into the blood purification tubing 370 and issues an alarm. Simultaneously with stopping the citric acid injection, the amount of sodium bicarbonate can be appropriately increased.

[0027] See Figure 4 and Figure 5 A third embodiment of the citrate anticoagulation adjustment system for blood purification according to the present invention includes: an in vivo free calcium detection device 100 for detecting in vivo free calcium levels; an in vitro free calcium detection device 310 installed on the blood purification pipeline 370 for detecting in vitro free calcium levels; a citrate injection device 340 installed on the blood purification pipeline 370 for injecting citrate; a sodium bicarbonate injection device 350 installed on the blood purification pipeline 370 for injecting sodium bicarbonate; and a control device 200 that receives the in vivo and in vitro free calcium detected by the in vivo free calcium detection device 100 and the in vitro free calcium detection device 310 respectively, and controls the citrate injection device 340 and the sodium bicarbonate injection device 350 to inject the citrate and sodium bicarbonate required for the treatment mode into the blood purification pipeline 370. The citrate injection device 340 and the sodium bicarbonate injection device 350 can also be injection devices that precisely control the amount of calcium chloride injected using micropumps.

[0028] Specifically, when the control device 200 determines that the in vivo free calcium detection value detected by the in vivo free calcium detection device 100 is within the target range for in vivo free calcium, it controls the citrate injection device 340 and the sodium bicarbonate injection device 350 to adjust the amount of citrate and sodium bicarbonate injected into the blood purification pipeline based on the in vitro free calcium value detected by the in vitro free calcium detection device 310. This includes: when the in vitro free calcium value detected by the in vitro free calcium detection device 310 is within the target range for in vitro free calcium, the control device 200 controls the citrate injection device 340 and the sodium bicarbonate injection device 350 to maintain the amount of citrate and sodium bicarbonate injected into the blood purification pipeline; when the in vitro free calcium value .... When the in vitro free calcium value detected by the in vitro free calcium detection device 310 is greater than the target range for in vitro free calcium, the control device 200 controls the citric acid injection device 340 to increase the amount of citric acid injected into the blood purification pipeline by a first increase, and controls the sodium bicarbonate injection device 350 to decrease the amount of sodium bicarbonate injected into the blood purification pipeline by a first decrease; when the in vitro free calcium value detected by the in vitro free calcium detection device 310 is less than the target range for in vitro free calcium, the control device 200 controls the citric acid injection device 340 to decrease the amount of citric acid injected into the blood purification pipeline by a second decrease, and controls the sodium bicarbonate injection device 350 to increase the amount of sodium bicarbonate injected into the blood purification pipeline by a second increase.

[0029] In the third embodiment of the citrate anticoagulation adjustment system, the target range for free calcium in vivo is 1.0-1.2 mmol / L; the target range for free calcium in vitro is 0.25-0.45 mmol / L; the first increase is 10 ml / h; the first decrease is 5 ml / h; the second decrease is 10-20 ml / h; and the second increase is 5-10 ml / h.

[0030] See Figure 7 and Figure 8 A fourth embodiment of the citrate anticoagulation adjustment system for blood purification of the present invention includes: an in vivo free calcium detection device 100 for detecting in vivo free calcium levels; an in vitro free calcium detection device 310 installed on the blood purification pipeline 370 for detecting in vitro free calcium levels; a citrate injection device 340 installed on the blood purification pipeline 370 for injecting citrate; a sodium bicarbonate injection device 350 installed on the blood purification pipeline 370 for injecting sodium bicarbonate; a blood flow adjustment device 361 installed on the blood purification pipeline 370 for adjusting blood flow; and a control device 200 that receives in vivo free calcium and in vitro free calcium detected by the in vivo free calcium detection device 100 and the in vitro free calcium detection device 310 respectively, and controls the blood flow adjustment device 361 to adjust the blood flow in the blood purification pipeline 370.

[0031] When the control device 200 determines that the in vivo free calcium detection value detected by the in vivo free calcium detection device 100 is within the target range for in vivo free calcium, it controls the blood flow adjustment device 361 to adjust the blood flow in the blood purification pipeline 370 according to the in vitro free calcium value detected by the in vitro free calcium detection device 310. Specifically, this includes: when the in vitro free calcium value detected by the in vitro free calcium detection device 310 is within the target range for in vitro free calcium, the control device 200 controls the blood flow adjustment device 361 to maintain the blood flow in the blood purification pipeline 370; when the in vitro free calcium value detected by the in vitro free calcium detection device 310 is greater than the target range for in vitro free calcium, the control device 200 controls the blood flow adjustment device 361 to maintain the blood flow in the blood purification pipeline 370; when the in vitro free calcium value detected by the in vitro free calcium detection device 310 is greater than the target range for in vitro free calcium, the control device 200 controls the blood flow adjustment device 361 to maintain the blood flow in the blood purification pipeline 370. When the free calcium level is reached, the control device 200 controls the blood flow adjustment device 361 to reduce the blood flow in the blood purification tubing 370 by a first reduction amount; when the in vitro free calcium level detected by the in vitro free calcium detection device 310 is greater than the first in vitro free calcium level, the control device 200 controls the blood flow adjustment device 361 to reduce the blood flow in the blood purification tubing 370 by a second reduction amount; when the in vitro free calcium level detected by the in vitro free calcium detection device 310 is less than the target range for in vitro free calcium, the control device 200 controls the blood flow adjustment device 361 to increase the blood flow in the blood purification tubing 370 by a first increase amount. The blood flow adjustment device 361 of this invention can be a blood pump.

[0032] In the fourth embodiment of the present invention, the target range of free calcium in vivo is 1.0-1.2 mmol / L; the target range of free calcium in vitro is 0.25-0.45 mmol / L; the first reduction rate is 5 ml / min; the second reduction rate is 10-20 ml / min; and the first increase rate is 10 ml / min.

[0033] The fourth embodiment of the citrate anticoagulation adjustment system of the present invention further includes a total calcium detection device 320 installed on the blood purification tubing 370. When the control device 200 determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device 200 determines whether to stop the infusion of citrate by the citrate infusion device 340 based on the total calcium value detected by the total calcium detection device 320 and the in vivo free calcium value detected by the in vivo free calcium detection device 100. Specifically, when the total calcium value / in vivo free calcium > 2.5 and the in vivo free calcium < 0.8 mmol / L, the control device 200 determines that citrate has accumulated, and controls the citrate infusion device to stop injecting citrate into the blood purification tubing 370 and issues an alarm. The amount of sodium bicarbonate can be appropriately increased while stopping the infusion of citrate.

[0034] See Figure 9 and Figure 10A fifth embodiment of the citrate anticoagulation adjustment system of the present invention includes: an in vivo free calcium detection device 100 for detecting in vivo free calcium levels; an in vitro free calcium detection device 310 installed on a blood purification pipeline 370 for detecting in vitro free calcium levels; a lactate detection device 110 installed on a blood purification pipeline 370 for detecting in vivo lactate; an HCO3 detection device 120 installed on a blood purification pipeline 370 for detecting in vivo HCO3; and an injection device 120 installed on a blood purification pipeline 370. Citric acid injection device 340; sodium bicarbonate injection device 350 installed on blood purification tubing 370 for injecting sodium bicarbonate; blood flow adjustment device 361 installed on blood purification tubing 370 for adjusting blood flow; control device 200 for adjusting blood flow in blood purification tubing 370 according to the detected levels of free calcium in vivo and free calcium in vitro, and for controlling citric acid injection and sodium bicarbonate injection according to the detected levels of free calcium in vivo, free calcium in vitro, lactic acid, and HCO3.

[0035] When the control device 200 determines that the in vivo free calcium detection value detected by the in vivo free calcium detection device 100 is within the target range of in vivo free calcium, it controls the blood flow adjustment device 361 to adjust the blood flow in the blood purification pipeline 370 according to the in vitro free calcium value detected by the in vitro free calcium detection device 310.

[0036] The main feature of the fifth embodiment is that when the control device 200 determines that the in vivo free calcium detection value is lower than the target range for in vivo free calcium and the in vitro free calcium detection value is lower than the target range for in vitro free calcium, the control device 200 determines whether to stop the citric acid injection device 340 from injecting citric acid based on the lactate value detected by the lactate detection device 110 and the HCO3 value detected by the HCO3 detection device 120. Specifically, when the current lactate value / previous lactate value > 1 and the current HCO3 / previous HCO3 < 1, the control device 200 determines that citric acid has accumulated, and controls the citric acid injection device to stop injecting citric acid into the blood purification tubing 370 and issues an alarm. The amount of sodium bicarbonate can be appropriately increased while stopping the citric acid injection.

[0037] This invention utilizes a dynamically optimized citrate anticoagulation regimen to significantly reduce anticoagulation-related complications and improve treatment efficacy and safety.

[0038] When this invention is applied to CRRT, both citrate and calcium pump are administered via a central venous catheter AV stopcock. In vivo free calcium detection device 100 and in vitro free calcium detection device 310 collect blood at the arterial end of the blood purification treatment and the arterial end blood sampling site, respectively, and perform blood gas analysis to obtain in vivo and in vitro free calcium levels.

[0039] This invention can dynamically optimize anticoagulation regimens in real time based on changes in blood gas during patient treatment, and identify risks in advance (such as the aggravation of metabolic acidosis when combined with abnormal liver function) through the "citric acid accumulation warning" function, providing clinical "monitoring-adjustment-early warning" closed-loop support. It is especially suitable for patients with complex conditions and large fluctuations in indicators, enhancing the adaptability of treatment plans and risk control capabilities.

[0040] This invention can be applied to the following scenarios: 1. Adjustment of anticoagulation regimen in CRRT (Continuous Renal Replacement Therapy) The system can be directly applied to departments such as ICU and nephrology that perform CRRT treatment, by analyzing in vivo / in vitro blood gas results (such as calcium) in real time. 2+ HCO3 - The system dynamically adjusts the citrate pump speed, blood flow, and sodium bicarbonate dosage (including indicators such as pH) to reduce the risk of vascular clotting and the incidence of complications such as hypocalcemic tetany and metabolic alkalosis. It is especially suitable for patients with complex conditions (such as those with abnormal liver function or metabolic acidosis) or those with large fluctuations in indicators.

[0041] 2. Blood purification treatments such as conventional hemodialysis / plasma exchange Citric acid anticoagulation is also applicable to routine hemodialysis, plasma exchange, and other scenarios. The system can be extended to these areas through parameter adaptation (such as adjusting blood flow rate and citric acid concentration threshold) to provide standardized anticoagulation adjustment guidance for different blood purification modes.

[0042] Although the present invention has been described in detail above, it is not limited thereto, and those skilled in the art can make various modifications based on the principles of the present invention. Therefore, all modifications made in accordance with the principles of the present invention should be understood to fall within the protection scope of the present invention.

Claims

1. A citrate anticoagulation modulation system for blood purification, comprising: In vivo free calcium detection device (100) for detecting the value of free calcium in the body; An in vitro free calcium detection device (310) for detecting in vitro free calcium levels is installed on the blood purification tubing (370). A citric acid injection device (340) for injecting citric acid is installed on the blood purification tubing (370). A sodium bicarbonate injection device (350) for injecting sodium bicarbonate is installed on the blood purification tubing (370). Total calcium detection device (320) installed on blood purification tubing (370); Based on the in vivo free calcium and in vitro free calcium detected by the in vivo free calcium detection device (100) and the in vitro free calcium detection device (310) respectively, the control device (200) controls the citric acid injection device (340) and the sodium bicarbonate injection device (350) to inject the citric acid and sodium bicarbonate required for the treatment mode into the blood purification pipeline (370). When the control device (200) determines that the in vivo free calcium detection value detected by the in vivo free calcium detection device (100) is within the target range of in vivo free calcium, it controls the amount of citric acid injected into the blood purification pipeline by the citric acid injection device (340) and the sodium bicarbonate injection device (350) according to the in vitro free calcium detection value detected by the in vitro free calcium detection device (310). If the in vivo free calcium detection value is within the target range of in vivo free calcium and the in vitro free calcium detection value is greater than the target range of in vitro free calcium, then the control device (200) controls the citric acid injection device (340) to increase the amount of citric acid injected into the blood purification pipeline by a first increase amount, and controls the sodium bicarbonate injection device (350) to decrease the amount of sodium bicarbonate injected into the blood purification pipeline by a first decrease amount. If the in vivo free calcium detection value is within the target range of in vivo free calcium and the in vitro free calcium detection value is less than the target range of in vitro free calcium, then the control device (200) controls the citric acid injection device (340) to reduce the amount of citric acid injected into the blood purification pipeline by a second reduction amount, and controls the sodium bicarbonate injection device (350) to increase the amount of sodium bicarbonate injected into the blood purification pipeline by a second increase amount. When the control device (200) determines that the in vivo free calcium detection value is lower than the target range of in vivo free calcium and the in vitro free calcium detection value is lower than the target range of in vitro free calcium, the control device (200) determines whether to stop the citric acid injection device (340) from injecting citric acid based on the total calcium value detected by the total calcium detection device (320) and the in vivo free calcium value detected by the in vivo free calcium detection device (100).

2. The citric acid anticoagulation adjustment system according to claim 1, wherein, If the in vivo free calcium detection value is within the target range for in vivo free calcium and the in vitro free calcium detection value is within the target range for in vitro free calcium, then the control device (200) controls the citric acid injection device (340) and the sodium bicarbonate injection device (350) to maintain the amount of citric acid and sodium bicarbonate injected into the blood purification pipeline.

3. The citric acid anticoagulation adjustment system according to claim 1 or 2, wherein, The target range for free calcium in vivo is 1.0-1.2 mmol / L; the target range for free calcium in vitro is 0.25-0.45 mmol / L; the first increase is 10 ml / h; the first decrease is 5 ml / h; the second decrease is 10-20 ml / h; and the second increase is 5-10 ml / h.

4. The citric acid anticoagulation adjustment system according to claim 1, wherein, When the total calcium value / free calcium in the body is >2.5 and the free calcium in the body is <0.8 mmol / L, the control device (200) controls the citric acid injection device to stop injecting citric acid into the blood purification pipeline (370).

5. The citric acid anticoagulation adjustment system according to claim 1 further includes: A blood flow adjustment device (361) for adjusting blood flow is installed on the blood purification tubing (370). When the control device (200) determines that the in vivo free calcium detection value detected by the in vivo free calcium detection device (100) is within the target range of in vivo free calcium, it controls the blood flow adjustment device (361) to maintain, increase or decrease the blood flow in the blood purification pipeline (370) according to the in vitro free calcium value detected by the in vitro free calcium detection device (310).

6. The citric acid anticoagulation adjustment system according to claim 5, wherein, The control device (200) controls the blood flow adjustment device (361) to maintain, increase, or decrease the blood flow in the blood purification tubing (370), including: If the in vitro free calcium value detected by the in vitro free calcium detection device (310) is within the target range of in vitro free calcium, then the control device (200) controls the blood flow adjustment device (361) to maintain the blood flow on the blood purification pipeline (370); If the in vitro free calcium value detected by the in vitro free calcium detection device (310) is greater than the first in vitro free calcium value of the target range of in vitro free calcium, then the control device (200) controls the blood flow adjustment device (361) to reduce the blood flow in the blood purification pipeline (370) by a first reduction amount. If the in vitro free calcium value detected by the in vitro free calcium detection device (310) is less than the target range of in vitro free calcium, the control device (200) controls the blood flow adjustment device (361) to increase the blood flow in the blood purification pipeline (370) by a first increase.

7. The citric acid anticoagulation adjustment system according to claim 5 or 6, wherein, The target range for free calcium in vivo is 1.0-1.2 mmol / L; the target range for free calcium in vitro is 0.25-0.45 mmol / L; the first reduction rate is 5 ml / min; and the first increase rate is 10 ml / min.

Images