Examination of the simple estimation method of the plasma
1), 2) 1) 2) , , , , Examination of the simple estimation method of the plasma refilling rate for the hemodialysis training simulator system Megumi TOKAJI 1), Shinji NINOMIYA2) 1) Major in Medical Engineering and Technology, Integrated Human Sciences Studies, Graduate School of Hiroshima International University 2) Department of Clinical Engineering, Hiroshima International University Abstract Because the numbers of hemodialysis patients are increasing, it is important to establish the educational procedure for clinical engineers to keep the safety of hemodialysis procedure. Therefore the development of the high-fidelity hemodialysis simulation system which can use for education of hemodialysis techniques is expected. To simulate the hemodynamic response of patients, it is necessary to develop the numerical model of patient’s condition during the hemodialysis. However, since the change of plasma refilling rate (PRR) and baroreflex control of the cardiovascular system affect the hemodynamics under dialysis intricately, construction of a correctly reproducible scientific model is very difficult. In this study, we investigated the simple estimation method to define the PRR from the patient’s initial conditions. We evaluated the PRR and circulating blood volume change during hemodialysis using CRIT-LINE in 17 patients under the constant ultrafiltration rate (UFR). Time-averaged PRR/UFR value was obtained as 0.8215 0.10 under the different total amount of ultra-filtration rate(UFR) and total blood volume. Hence we found the PRR value can estimate from UFR directly by using the proper PRR/UFR coefficient. This simple estimation method seems to be effective to construct the practical model which can simulate the hemodynamic response under hemodialysis. keywords: plasma refilling rate, hematocrit sensor, total blood volume, patient simulator, hemodialysis 㸇䋮✜⸒㩷 䋲䋮⋡⊛ 䋱䋮⢛᥊ 㩷 ㅘᨆਛ䈱ᓴⅣⴊᶧ㊂䈲䇮ⴊẏ᥏⾰ᶐㅘ䇮⤔⾰ᶐ ㅘᨆᖚ⠪ᢙ䈲 26 ਁੱ䉕䈋ᐕ䈮⚂ 1 ਁੱ䈝 ㅘ䈱ᄌേ䇮ᄌ឵䈭䈬䈮䉋䉍ᄌൻ䈜䉎䈏䇮ᦨ䉅ᓴ 䈧Ⴧട䈚䈩䈇䉎ਛ䇮ㅘᨆᛛⴚ⠪䈮ኻ䈜䉎ੱᎿㅘᨆⵝ Ⅳⴊᶧ㊂ᄌൻ䈮ᓇ㗀䉕ਈ䈋䉎ⷐ࿃䈲䇮㒰᳓ㅦᐲ䈫䈠 ⟎䈱ో䈭ᠲᛛⴚ䈱⠌ᓧ䈏᳞䉄䉌䉏䈩䈇䉎䇯ⴊᶧ 䉏䈮ኻᔕ䈜䉎 Plasma refilling rate (PRR)䈱ᄌൻ䈪䈅 ㅘᨆ≮ᴺਛ䈲ⴊᶧ䈏ᄖᓴⅣ䈚䈩䈇䉎䈢䉄䇮↢⊛ 䉎䇯 䈶ᯏ᪾⊛䊃䊤䊑䊦⊒↢ᤨ䈮䈲ㅦ䉇䈎䈮ኻಣ䈜䉎䈖 ᧄ⎇ⓥ䈪䈲䇮ㅘᨆ䊃䊧䊷䊆䊮䉫䈮䈍䈔䉎ᗐᖚ⠪ 䈫䈏㊀ⷐ䈪䈅䉍䇮್ᢿ䉕⺋䉎䈫⥌ᱫ⊛䈭䈮䈧䈭䈏 䊝䊂䊦䈱ᓴⅣⴊᶧ㊂ᄌൻ䉕ᔅⷐᦨዊ㒢ᐲ䈱䊌䊤䊜 䉎ෂ㒾ᕈ䈏䈅䉎䇯䉁䈢䇮䊃䊤䊑䊦⊒↢೨䈮䈠䈱ళ䉕 䊷䉺䈮䉋䉍ផቯ䈜䉎䈢䉄䇮⥃ᐥㅘᨆ䈮䈍䈔䉎ဋ╬㒰 ੍᷹䈚䈩䈠䉏䉕࿁ㆱ䈜䉎䈖䈫䈏ᦸ䉁䈚䈇䈱䈲⸒䈉䉁䈪 ᳓ਛ䈱䊓䊙䊃䉪䊥䉾䊃(Ht)ᄌൻ䈱ታ᷹୯䈎䉌ផቯ䈘䉏 䉅䈭䈇䇯䈚䈎䈚⊛⏕䈭್ᢿ䈮䈲䇮↢ℂቇ⊛⍮⼂䈫Ꮏ 䉎ᓴⅣⴊᶧ㊂ᄌൻ䉋䉍䇮ㅘᨆਛⴊⴕേᘒᄌൻ䈱ⷐ࿃ ቇ⊛⍮⼂䈱ਔᣇ䈏ⷐ᳞䈘䉏䉎 䈱䋱䈧䈪䈅䉎 PRR 䉕䇮ㅘᨆᴦ≮᧦ઙ䈎䉌ቯ⺰⊛䈮 1) 䇯ㅘᨆᛛⴚ䈱䊃䊧䊷 䊆䊮䉫䈲䇮䈖䉏䉁䈪⓫ೝ䊶䊒䊤䉟䊚䊮䉫䈮ઍ䈘䉏䉎‛ ◲ᤃផቯ䈜䉎ᚻᴺ䉕ᬌ⸛䈜䉎䇯 ℂ⊛䈭ᚻᛛ䈱ᢎ⢒䈏ਛᔃ䈪䈅䉍䇮↢ℂቇ⊛⍮⼂䈫Ꮏ ቇ⊛⍮⼂䈱㜞ᐲ䈭ᔕ↪䈪䈅䉎ㅘᨆᛛⴚ䉕⠌ᓧ䈜䉎 㸈䋮ኻ⽎䈍䉋䈶ᣇᴺ㩷 䈮䈲లಽ䈪䈲䈭䈎䈦䈢䇯 䋱䋮 ኻ⽎ ⥃ᐥ䈮䈍䈔䉎✕ᕆᘒ䈮ኻ䈜䉎ኻಣ⸠✵䉕ቯᦼ ᐢፉᄢቇ∛㒮䈮䈍䈇䈩ᘟᕈㅘᨆ䉕ᣉⴕ䈚䈩䈇䉎 ⊛䈎䈧⛮⛯⊛䈮ታᣉ䈜䉎䈢䉄䈮䈲䇮ㅘᨆ᧦ઙ䈮䉋䉍 17 ฬ䉕ኻ⽎䈫䈚䇮ᕈ䈲↵ᕈ 11 ฬ䇮ᅚᕈ 6 ฬ䈪䈅䈦 ⶄ㔀䈮ᄌൻ䈜䉎ᖚ⠪⁁ᘒ䉕㜞䈇䊧䊔䊦䈪ౣ䈪䈐䉎 䈢䇯ኻ⽎⠪䈱∝䈱ౝ⸶䋨♧ዩ∛䇮♻⣢Ἳ╬䋩 ᢎ⢒↪ੱᎿㅘᨆ䉲䊚䊠䊧䊷䉺䈱ㆡ↪䈏ല䈪䈅䉎䈫 䈱⚦䈲ᄙጘ䈮䉒䈢䈦䈩䈇䉎䇯ဋ╬㒰᳓䈮䈍䈇䈩ⴊ ᕁ䉒䉏䉎䈏䇮⪺⠪䉌䈲䈠䈱᭴ᚑ䈫䈚䈩䇮䉮䊮䊏䊠䊷䉺 䈏ਇቯ䈫䈭䉎ᖚ⠪䈲࿁䈱ኻ⽎䈎䉌㒰䈇䈢䇯ᧄ 䉲䊚䊠䊧䊷䉲䊢䊮䈮䉋䉎ᗐᖚ⠪䊝䊂䊦䈫䇮ㅘᨆⵝ⟎ ⎇ⓥ䈮䈍䈇䈩䈲䇮೨䈮⎇ⓥ⋡⊛䊶ౝኈ䉕ᖚ⠪䈮⺑ 䈫䈱䉟䊮䉺䊷䊐䉢䊷䉴䈫䈭䉎ᮨᡆᓴⅣ࿁〝䉕ⶄว䈘䈞 䈚䇮↢ᖱႎ䈱⎇ⓥ↪䈍䉋䈶⺰ᢥឝタ䈮ኻ䈚䈩 䈢䊊䉟䊑䊥䉾䊄䊶䉲䊚䊠䊧䊷䉲䊢䊮䊝䊂䊦 หᗧ䉕ᓧ䈢ᖚ⠪䈮ኻ䈚䈩䊂䊷䉺㓸䉕ታᣉ䈚䈢䇯 2) 䈱ㆡ↪䉕᭴ ᗐ䈚䈩䈇䉎䇯ೞ䇱ᄌൻ䈜䉎⥃ᐥㅘᨆ䈱⁁ᴫ䉕ౣ䈜 䉎䈮䈲䇮ㅘᨆ࿁〝䊶ⵝ⟎䈱‛ℂ⊛ౣ䈣䈔䈪䈲䈭䈒䇮 䋲䋮 ᣇᴺ PRR 䈲䇮CRIT-LINETM Monitor䋨Inline Diagnostic 䈠䈱ᠲ䈮ኻ䈜䉎ᖚ⠪䈱↢ᔕ䉕ౣ䈜䉎ᗐ ᖚ⠪䊝䊂䊦(Virtual patient model)䈏ਇนᰳ䈪䈅䉎䇯 ␠䇮એਅ CLM 䈫⒓䈜䉎䋩䉕↪䈇䉎䈖䈫䈪Ყセ⊛ኈ ㅘᨆਛ䇮․䈮㗴䈫䈭䉎ᖚ⠪䈱↢ᔕ䈫䈚䈩 ᤃ䈮᷹ቯ䈜䉎䈖䈫䈏น⢻䈪䈅䉎䇯CLM 䈱᥉䈮䉋䉍 䈲䇮⇣Ᏹૐⴊ䈶㜞ⴊ䈏䈕䉌䉏䉎䇯䈠䈱ⴊⴕ PRR 䈱᷹ቯ䈲⋓䉖䈮ⴕ䉒䉏䈩䈇䉎䈏䇮䈠䈱᷹ቯᣇᴺ േᘒᄌൻ䈱ⷐ࿃䈫䈚䈩䈲䇮㒰᳓䈮䉋䉎ᓴⅣⴊᶧ㊂ᄌ 䈫⚿ᨐ䈲⎇ⓥ⠪Ფ䈮⇣䈭䉍⏕┙䈘䉏䈢ᣇᴺ䈏䈭䈇䈱 ൻ䈍䉋䈶↢䈱ⴊ▤ᓮ䈮䉋䉎ⴊ▤ᛶ᛫䊶䉮䊮䊒䊤䉟 䈏⁁䈪䈅䉎䇯 䉝䊮䉴䈱ᄌൻ䈏䈕䉌䉏䉎䈏䇮䈠䈱ᄌൻ䈲ⶄ㔀䈪ᄙ 㩷 ᧄ⎇ⓥ䈪䈲䇮ጊਛ䉌䈮䉋䈦䈩⺞ᩏ䈘䉏䈢䇮CLM 䈮䉋 䈒䈱⎇ⓥ䈮䉅㑐䉒䉌䈝⸃䈘䉏䈩䈇䈭䈇ㇱಽ䉅ᄙ䈒ሽ 䈦䈩᷹ቯ䈘䉏䈢ኻ⽎⠪䈱 Ht ᄌൻ䈱ታ᷹୯䉋䉍 PRR 䈚䇮ో䈩䉕䉲䊚䊠䊧䊷䉲䊢䊮䈮䉋䉍ᱜ⏕䈮ౣ䈜䉎䈖 䉕ផቯ䈜䉎ઍ⊛䈭ᣇᴺ䋳)䉕Ყセᬌ⸛䈚䇮ᖚ⠪䈱ᴦ 䈫䈲࿎㔍䈪䈅䉎䇯䉲䊚䊠䊧䊷䉲䊢䊮⸃ᨆᚻᴺ䉕ᢎ⢒䈮 ≮᧦ઙ䈮ో䈒ᓇ㗀䈏䈭䈒䇮䈎䈧◲ଢ䈪䈅䉎એਅ䈱ᚻ ᔕ↪䈜䉎႐ว䈮䈲䇮ᖚ⠪䈱ઍ⊛䈭േ䉕䉒䈎䉍䉇 㗅䈮䉋䉍 PRR 䈱ផቯ䉕ⴕ䈦䈢䇯 䈜䈇䊝䊂䊦䈪ౣ䈜䉎ᔅⷐ䈏䈅䉎䇯䈧䉁䉍䇮ⶄ㔀䈫䈭 A 1 ࿁ 䈱 ᴦ ≮ 䈮 䈍 䈔 䉎ᓴ Ⅳ ⴊ ᶧ ㊂ ᄌ ൻ ₸ 䋨 㰱 䉌䈭䈇ᔅⷐᦨዊ㒢ᐲ䈱䊌䊤䊜䊷䉺䈮䉋䉎◲ᤃ䊝䊂䊦 BV%䋩䈱ផቯ㩷 䈱᭴▽䈏㊀ⷐ䈪䈅䉎䇯 ㅘᨆᴦ≮㐿ᆎ䈎䉌⚳ੌ䉁䈪㒰᳓ㅦᐲ 㪬㪝㪩㪲㫄㫃㪆㪿㪴 䉕৻ቯ䇮ᴦ≮⚳ੌ䉁䈪䈱ᤨ㑆䉕䌴㪲㪿㫆㫌㫉㪴䇮㪚㪣㪤 䈮䉋 䈮䈲䇮㪤㫀㪺㫉㫆㫊㫆㪽㫋㩷 㪜㫏㪺㪼㫃㩷 㪉㪇㪇㪊㩿㪤㫀㪺㫉㫆㫊㫆㪽㫋 ␠㪀䉕↪䈚䈢䇯㩷 䉍᷹ቯ䈘䉏䈢ᴦ≮㐿ᆎᤨ䈱 㪟㫋 ୯䉕 㪟㫋㩿㪇㪀䇮ᓴⅣⴊ 㩷 ᶧ㊂䉕 㪙㪭㩿㪇㪀䇮⚳ੌᤨ䈱 㪟㫋 ୯䉕 㪟㫋㩿㫋㪀䇮ᓴⅣⴊᶧ 㸉䋮㩷 ⚿ᨐ㩷 ㊂䉕 㪙㪭㩿㫋㪀䈫䈜䉎䇯㩷 㪚㪣㪤 䉕↪䈇䈢ᘟᕈㅘᨆᖚ⠪䈱ᴦ≮㐿ᆎᤨ 㪟㫋 ୯ ᓴⅣⴊᶧਛ䈱✚ⴊ㊂䈲ᄌൻ䈚䈭䈇䈖䈫䈎䉌䇮ᴦ 䈍䉋䈶ᴦ≮⚳ੌᤨ 㪟㫋 ୯䇮ᖚ⠪㊀䉋䉍 㪈㪎 ฬ䈱ኻ⽎ ≮೨䈱ᓴⅣⴊᶧ㊂䉕 㪙㪭㩿㪇㪀䇮㩷 ⠪䈱㰱㪙㪭 䈶 㪧㪩㪩 䉕▚䈚䈢䇯⚿ᨐ䉕䋱䈮␜䈜䇯 BV (0) ⋅ Ht (0) = BV (t ) ⋅ Ht (t ) 㩷 䍃䍃䍃䍃䍃㩿㪈㪀㩷 ฦኻ⽎⠪䈱ᴦ≮ೋᦼ᧦ઙ䈪䈅䉎ᴦ≮㐿ᆎ೨㊀䊶 䈱㑐ଥ䈏ᚑ䉍┙䈧䇯䈚䈢䈏䈦䈩ᓴⅣⴊᶧ㊂䈱ᄌൻ 㐿ᆎᤨᐔဋⴊ䈶 㪬㪝㪩 䈫 㪧㪩㪩 䈱⋧㑐䉕ᬌ⸛䈚䈢 䈫 㪟㫋 ᄌൻ䈱㑐ଥ䈲䇮㩷 ⚿ᨐ䇮㪬㪝㪩䋭㪧㪩㪩 㑆䈱⋧㑐ଥᢙ䈲 㪇㪅㪐㪎䋨࿑ 㪈 ෳᾖ䋩 BV (t ) Ht (0) = 㩷 㩷 㩷 㩷 㩷 㩷 䍃䍃䍃䍃䍃䍃㩿㪉㪀㩷 BV (0) Ht (t ) 䈫䈭䉍䇮ᴦ≮㐿ᆎ೨㊀䋭㪧㪩㪩 㑆䈱⋧㑐ଥᢙ 㪇㪅㪉㪉 䋨࿑ 㪉 ෳᾖ䋩䇮ᴦ≮㐿ᆎᤨᐔဋⴊ䋭㪧㪩㪩 㑆䈱⋧㑐 䈫䈭䉎䇯৻ᣇ䇮㫋 ᤨ㑆ᓟ䈱ᓴⅣⴊᶧ㊂ᄌൻ₸䉕㰱 ଥᢙ 㪇㪅㪋㪈䋨࿑ 㪊 ෳᾖ䋩䈫Ყセ䈚䈩㕖Ᏹ䈮㜞䈇⋧㑐㑐 㪙㪭㩼䈫䈜䉎䈫䇮㩷 ଥ䈏䈅䉎䈖䈫䈏䉒䈎䈦䈢䇯㊀䊶ᐔဋⴊ╬䈱ೋᦼ᧦ § BV (t ) · ΔBV % = ¨¨ − 1¸¸ ⋅100 㩷 㪲㩼㪴䍃䍃䍃䍃㩿㪊㪀㩷 © BV (0) ¹ ઙ䈱㆑䈇䈮㑐䉒䉌䈝䇮 㪧㪩㪩 䋯 㪬㪝㪩 ୯䈲䇮㪇㪅㪏㪉㪈㪌㫧 㪇㪅㪈㪇 䈫䈭䈦䈢䇯㩷 એ䈱ᬌ⸛䉋䉍䇮ቯ䈚䈢ᘟᕈㅘᨆᖚ⠪䈱႐ว䇮 㩷 㩿㪉㪀㪃㩿㪊㪀ᑼ䉋䉍䇮㩷 § Ht (0) · ΔBV % = ¨¨ − 1¸¸ ⋅100 㩷 㪲㩼㪴䍃䍃䍃䍃䍃㩿㪋㪀㩷 © Ht (t ) ¹ 䈮䈍䈇䈩㩿㪏㪀ᑼ䈮␜䈜㑐ଥᑼ䈏ᚑ䉍┙䈧䈖䈫䈏䉒䈎䈦 㩷 䈢䇯㩷 㪙㩷 㩷 ᓴⅣⴊᶧᄌൻ㊂㰱㪙㪭 䈱ផቯ㩷 㪬㪝㪩 䈫 㪧㪩㪩 䈮䈲䇮⚻ᤨᄌൻ䉕⠨ᘦ䈚䈭䈇ᤨ㑆ᐔဋ୯ 㪧㪩㪩㩷 䋽㩷 㩿㪇㪅㪏㪉㪈㪌㫧㪇㪅㪈㪇㪀㬍㪬㪝㪩㩷㪲㫄㫃㪆㪿㪴㩷 䊶䊶䊶䊶䊶㩿㪏㪀㩷 ᴦ≮೨ᓴⅣⴊᶧ㊂ 㪙㪭㩿㪇㪀䉕䇮ᴦ≮೨㊀ 㪮㪇㪲㫂㪾㪴 䈖䈱㑐ଥ䉋䉍䇮㪧㪩㪩 䈱⚻ᤨᄌൻ䉕⠨ᘦ䈚䈭䈇᧦ઙ 䈱 㪏䋦䈫ቯ䈜䉎䇯㩷 ਅ䈪䈲䇮ᖚ⠪䈱㊀䊶ᐔဋⴊ䈱Ꮕ⇣䈮㑐䉒䉌䈝 BV (0) = W0 × 0.08 × 1000 㩷 㪲㫄㫃㪴㩷 㩷 䍃䍃䍃䍃䍃㩿㪌㪀㩷 㪬㪝㪩 䈎䉌◲ଢ䈮 㪧㪩㪩 䉕ផቯ䈪䈐䉎น⢻ᕈ䈏䈅䉎䈖䈫 㩿㪋㪀㪃㩿㪌㪀ᑼ䉋䉍䇮ᓴⅣⴊᶧᄌൻ㊂㰱㪙㪭 䈲䇮㩷 䈏䉌䈎䈮䈭䈦䈢䇯㩷 ΔBV = BV (0) ⋅ ΔBV % 㩷 㩷 㪲㫄㫃㪴㩷 䍃䍃䍃䍃䍃䍃㩿㪍㪀㩷 100 㩷 ᷹ቯ䈮䈲䇮㪚㪩㪠㪫㪄㪣㪠㪥㪜㪫㪤㩷㪤㫆㫅㫀㫋㫆㫉㸉㩿㪠㫅㫃㫀㫅㪼㩷㪛㫀㪸㪾㫅㫆㫊㫋㫀㪺 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 ␠䇮࿖ౝ⽼ᄁర㩷 㪡㪤㪪 ᩣᑼળ␠㪀䉕↪䈇䇮䊂䊷䉺⸃ᨆ 㪚㩷 㩷 㫇㫃㪸㫊㫄㪸㩷㫉㪼㪽㫀㫃㫃㫀㫅㪾㩷㫉㪸㫋㪼㩷㩿㪧㪩㪩㪀㩷 䈱ផቯ㩷 㪈 ࿁䈱ᴦ≮ਛ䈮䈍䈔䉎ታ㓙䈱㒰᳓ㅦᐲ䉕 㪬㪝㪩㪲㫄㫃㪆㪿㪴䈫䇮㪟㫋 ୯䈱ᄌൻ䈮䉋䉍▚䈚䈢㰱㪙㪭 䈫 䈱Ꮕ䈏䇮㫋 ᤨ㑆⚻ㆊ䈜䉎䉁䈪䈱 㪧㪩㪩 䈱ᐔဋ୯䈪䈅 䉎䈫⠨䈋䇮㪧㪩㪩 䉕એਅ䈱䉋䈉䈮ផቯ䈚䈢䇯㩷 PRR = UFR + ΔBV 㩷 㪲㫄㫃㪆㪿㪴㩷 㩷 䍃䍃䍃䍃䍃䍃㩿㪎㪀㩷 t ᐕ㦂䇮ᕈ䇮ᩰ䇮∝䇮䈍䉋䈶⸳ቯ䈘䉏䈢 㪬㪝㪩 䈏⇣䈭䉎 㪈㪎 ฬ䈱ኻ⽎⠪䈮ኻ䈜䉎 㪟㫋㩿㪇㪀㪃㩷 㪟㫋㩿㫋㪀䈱᷹ቯ ⚿ᨐ䈎䉌ផቯ䈘䉏䈢ᖚ⠪Ფ䈱 㪧㪩㪩 䈫䇮ᴦ≮᧦ઙ䋨ᴦ ≮㐿ᆎᤨⴊ䇮㊀䇮㪬㪝㪩䋩䈫䈱⋧㑐䉕⺞䈼䇮ᴦ≮᧦ ઙ䈎䉌 㪧㪩㪩 䉕⋥ធផቯ䈪䈐䉎ᢙ୯䊝䊂䊦䉕ᬌ⸛䈚䈢䇯
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