RU2565656C2 - Body detoxification method and device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to medical equipment, nephrology, urology, toxicology and resuscitation, replacement therapy (RT) and detoxification systems and can be used in treating patients with renal failure, for replacing a lost function of metabolite and toxic clearance. The RT is combined with extracorporeal blood radiation; that is ensured by patient's blood sampling through an arterial needle (AN) or an arterial fistula needle (AFN) inserted into a peripheral artery or a fistula, blood passing through a fluid circuit of a blood line in sterile connecting hoses, blood passing through an electromagnetic emitter (EME) mounted in front of a dialysis unit connected to a dialysate inlet and outlet systems. The blood is re-irradiated and introduced into the patient's peripheral vein or fistula. An arterial blood pressure (ABP) is measured before the blood is pumped out, and a venous blood pressure (VBP) is measured before the blood is supplied back to the patient. Before the blood is supplied into the dialysis unit, it is heparinised; the dialysate pumped therein from the inlet system. After the re-radiation, the blood flows into an air trap (AT). That is combined with supravenous blood electromagnetic radiation within a point of radiation and a point of blood introduction into the patient. The method is implemented by using a device comprising an AN or an AFN, series sterile connecting hoses in a fluid circuit of a cyclic blood line, a blood pump, a blood electromagnetic pre-radiation unit, a dialysis unit with connected dialysate inlet and outlet units, an electromagnetic radiation unit for the blood passed through the dialysis unit, venous needle or venous fistula needle. An AD sensor is mounted in front of the blood pump, and a VP sensor is mounted behind the AT before the blood is supplied back to the patient. A heparin pump is mounted in front of the dialysis unit; the AT is mounted behind the radiation for the blood passed through the dialysis unit. Two supravenous blood electromagnetic radiation units are mounted within a point of blood sampling and introducing into the patient's bloodflow. The electromagnetic radiation is blue, or ultraviolet, or laser light. The radiation procedure is repeated more than once continuously during a detoxification session for at least 3 hours.

EFFECT: method enables providing the high-quality detoxification in the patients with renal failure, preventing sides effects and complications, including within regions of vascular approach.

14 cl, 1 dwg, 1 ex

Description

The invention relates to medical equipment, more specifically, to replacement therapy systems and detoxification apparatus of the body, and can be used to treat patients suffering from renal failure, in order to replace the lost function of eliminating metabolites and toxic substances from the body.

The invention can be used, for example, in nephrology, urology, toxicology and resuscitation.

Currently, in clinical practice for the treatment of acute and chronic renal failure in order to terminate the toxins and to eliminate them from the body, the following methods of extracorporeal detoxification of the body (dialysis and filtration methods of hemocorrection) are distinguished [1-2]:

1. hemodialysis, during which the dialysis solution interacts with blood through a semipermeable membrane, as a result of which the substances dissolved in the blood are removed from it by diffusion, which helps to restore electrolyte and water balance;

2. hemofiltration, during which blood purification occurs by convection transport of substances dissolved in blood plasma through a highly porous membrane due to the creation of transmembrane pressure;

3. hemodiafiltration, which is a combination of the principles of diffusion and convection;

4. ultrafiltration, in which, at the same time as dialysis, excess fluid is removed from the body, which, despite the complexity of technical implementation, is used in the treatment of patients with endogenous intoxication, acute hepatic-renal failure with hyperhydration [2-5].

Hemodialysis has received the greatest clinical use as one of the most universal and effective methods of efferent medicine and renal replacement therapy [3-4]. In the hemodialyzer, which is the main element of the "artificial kidney" - a system for hemodialysis, mass transfer occurs through a semipermeable membrane from the blood into the dialysis solution of the ions that make up the blood plasma (sodium, potassium, calcium, magnesium, chlorine, phosphorus, etc. ), organic waste products of the body (urea, creatinine, uric acid, etc.), as well as the removal of excess water from the body. Naturally membranes (serous membranes) and artificial membranes (cellophane, etc.) are usually used as dialyzer membranes [5-6].

A known method of blood purification in the treatment of patients suffering from renal failure, which consists in sequentially passing blood through a hemofiltration element and a hemodialysis element, and ultrafiltrate - through the outlet connector of the hemofiltration element and a filter (for example, from activated carbon), after which the regenerated ultrafiltrate is introduced into the stream purified blood. Thus, purified ultrafiltrate is used as a reinfusion solution for repeated administration to the patient [7].

The disadvantage of this method, which is based on such well-known methods as hemodialysis, ultrafiltration and hemosorption, is the technical complexity of its implementation. The main disadvantage is that the negative effect on the body with this method of blood purification is due to the prolonged contact of the ultrafiltrate with activated charcoal, used as a sorbent. For the ultrafiltrate purification filter, it is necessary to make increased demands that activated carbon without a shell does not meet, because, as you know, activated carbon has extremely low bio- and hemocompatibility, and when it comes into contact with blood, it causes depletion of red blood cells, platelets, white blood cells and other blood components , which leads to a deterioration in the well-being of patients. At the same time, the measures taken in this method to protect against complications, in particular, the use of an additional gauze filter or charcoal hemoperfusion cartridge, are ineffective and insufficient, both to ensure the safety of the patient and to conduct a high-quality detoxification procedure. All this leads to low efficiency of sorption of toxins in this way [7].

There is a method of treating renal failure, which consists in the combined effects of bicarbonate hemodialysis, hemodiafiltration and separate ultrafiltration of blood, drug nephroprotective therapy with the additional use of automated management of hemodialysis database, processing and prompt calculation of the initial data for the treatment of renal failure of each patient by organizing and applying visual diagrams drawings, speech comments, graphic images, electron tables and the introduction of objects of urological information about patients in the visual editing mode with the display of data on the time, quantity, doses of administration and administration of the prescribed drugs, indicating the diagnoses and names of the patients who received these drugs, while drug therapy is carried out with using the drug erythropoietin - an endogenous glycoprotein hormone that regulates the production of red blood cells - and the preparation of keto acids in combination with nephroprotective ter Pia as a low-protein diet, angiotensin converting enzyme blockers, beta-blockers, diuretics, [8].

This method has the following disadvantages: it is technically difficult to implement due to the use of a whole range of detoxification procedures, in addition, it requires the use of highly specialized pharmacological preparations, the use of erythropoietin and ketoacids, which can cause an undesirable allergic reaction and additional load on the liver in a weakened body, and use of a hemodialysis database with the declared parameters, the ability to process and quickly calculate data, organize Yes, on the display of graphic and other information, as well as with the presence of a visual editing mode, it requires significant computing power of a computer, in particular, the use of a powerful graphic adapter, which leads to an increase in the cost of equipment necessary for implementing the method [8].

Along with hemodialysis in clinical practice, methods of extracorporeal blood irradiation (EOK) [9-10] are used, for example, extracorporeal laser blood irradiation (ELOK) [11-12], ultraviolet (UV) blood irradiation (EUFOK, UFOK) or blue light irradiation [13-14]. Separately, both hemodialysis machines ("artificial kidney") and blood irradiation devices (ELOK or EUFOC) exist and are used for detoxification in renal failure, however, the most pronounced therapeutic effect is achieved when these methods are used simultaneously with each other. In patients with renal failure, there is a dysfunction of blood cells, manifested by the activation of free radical oxidation in platelets and red blood cells, impaired aggregation of red blood cells and platelets. In addition, during hemodialysis, along with toxins, a number of useful substances are removed from the blood, which leads to various complications and requires additional procedures to adjust the blood composition. Due to hemodialysis, not only the concentration of uremic toxins in the blood plasma is reduced, but also the prerequisites for the correction of anemia are created, however, this requires the introduction of special drugs - recombinant erythropoietins and iron preparations.

By combining two procedures of extracorporeal detoxification of the body - hemodialysis and EOC (for example, laser blood irradiation, blue light irradiation or UFOK), a reduction in the toxic load on the body is achieved. The blood purified in this way returns to the tissues of the body and again takes on the uremic toxins in them, the cycle repeats. Thus, during the procedure, the body is gradually cleared of uremic toxins, and EOK maintains the body's immune status by exerting a bactericidal and anti-inflammatory effect, increasing the oxygen capacity of the blood and improving the oxygenation of organs and tissues, normalizing and stimulating regenerative and metabolic processes in the body, and also improving functional properties of red blood cells. With UFOA, blood viscosity decreases (by about 30%), the adhesion of its cells decreases, reducing the formation of blood clots, and old blood clots resolve faster [13-14]. The bactericidal effect of UV radiation is most specific for short-wave ultraviolet rays (KUV, wavelength 180-280 nm). Streptococcus, Staphylococcus aureus, Escherichia coli are most sensitive to UV radiation. When blood is irradiated with KUV rays, its bactericidal activity increases [13].

A known method of ultraviolet irradiation of a blood flow by passing blood in the gap between two coaxial cylinders and irradiating it with rays from a cylindrical ultraviolet radiation source through the side surface of the inner quartz cylinder, in order to ensure uniform blood irradiation and protect blood elements from thermal and mechanical damage, the cylinders are positioned vertically and irradiate the free surface of the blood stream flowing down the lateral surface of the outer cylinder, p between the cylinder exceeds the thickness of the layer flowing blood, and the dose is selected and can vary depending on the severity of the disease, condition veins and age of the patient [15].

The disadvantage of this method is the complexity of the technical implementation of the method in the manufacture of the emitter, as well as the use of only extracorporeal blood irradiation, which is insufficient for replacement therapy and detoxification of the body of patients with renal dysfunction, since in this case other methods of extracorporeal hemocorrection are also necessary.

A known method for extracorporeal blood purification by irradiation with ultraviolet light and plasma filtration [16]. The method consists in using a double-circuit extracorporeal system for purification and detoxification of blood, including the movement of blood taken from the femoral artery or vein with a peristaltic pump along a closed circuit with subsequent processing of blood by sequential passing through the toxin inactivation device, where it is exposed to ultraviolet radiation in the range of 200-280 nm in a special unit with serpentine ultraviolet lamps, then passing the irradiated blood through h block hemoconcentrator in the primary circuit and through the plasma filtration unit in the secondary circuit.

The disadvantage of this method is that the method is complicated in terms of technical implementation and does not provide full replacement therapy for renal failure, since it does not imply the use of the principle of dialysis; only one type of radiation (ultraviolet) is used to affect the patient’s blood, and there is a very high probability of injury to blood elements as a result of heat exposure when moving along a complex closed path in the flow system.

A known method of hemodialysis [17], adopted by us as a prototype. The method consists in passing blood through an extracorporeal circuit and simultaneously irradiating it with continuous near-infrared radiation at a wavelength of 500-850 nm, then it is pumped through a blood pump through a dialyzer connected to the dialysis fluid inlet and outlet systems, and the spent dialysate is released using a pump, then blood is passed through a second blood irradiator and returned to the patient.

The disadvantage of this prototype method is the use of a narrow region of the spectrum of electromagnetic radiation in the visible part of the spectrum and in a small part of the near infrared (IR) range. The use of radiation in the range from 850 to 1300 nm, i.e. in the upper part of the so-called therapeutic transparency window [18-19] will make the detoxification procedure more effective than at the wavelengths proposed in [17]. In addition, the method does not provide heparinization to artificially reduce blood coagulation by introducing heparin into the bloodstream. Also, the method does not allow to take into account arterial and venous pressure in the blood supply line and does not provide for air removal measures at the outlet of the line before blood enters the patient's body. The method does not take into account any measures to prevent complications in the field of vascular access associated with clogging or infection of fistulas in places of blood sampling and return. All this makes the method ineffective and inapplicable for detoxification of the organism of patients with renal failure.

A device for purifying blood from uric acid and creatinine in the treatment of patients suffering from renal failure [7], consisting of a hemofiltration element and a hemodialysis element connected in series in a closed extracorporeal circuit, the ultrafiltrate being passed through the outlet connector of the hemofiltration element and a filter in which, as The adsorbent uses activated carbon.

The device is not only technically difficult to implement, but also does not provide sufficient protection for the patient from side effects that occur when using activated carbon, which has poor biocompatibility and hemocompatibility. When such an adsorbent comes in contact with blood, patients feel worse, however, the measures taken to minimize the negative consequences of using activated carbon in the form of using an additional gauze filter or charcoal hemoperfusion cartridge are not effective enough. All this leads to low efficiency of sorption of toxins in such a device.

A device for ultraviolet irradiation of a blood stream "violet" [15]. This device for flowing irradiation of human blood with UV rays in order to uniformly irradiate blood and protect blood elements from thermal and mechanical damage involves the use of a vertically oriented cylindrical source of UV radiation and two coaxial cylinders (internal - quartz and external - from ordinary glass) mixed with lead; the source features are an increased clearance between the cylinders, a special design of the upper annular tube and the presence of a screen, moving Gosia along the UV source).

The disadvantage of this device is the difficulty of technical implementation in the manufacture of the emitter, as well as the use of only ultraviolet radiation, which is insufficient for replacement therapy and detoxification of the body of patients with renal dysfunction.

A device is known for therapeutic irradiation of biological liquid media [20], designed to inactivate microorganisms in biological fluids, in which the liquid moves under the action of a peristaltic pump through a flow system zigzag mounted in a horizontal plane in the irradiator module, which is staggered on two levels ultraviolet lamps. To achieve uniform blood irradiation in the flow system, elements that create the effect of mixing the flow are installed at the level of UV radiation sources.

The disadvantage of this device is the complexity of its technical implementation, as well as a very high risk of damage to blood elements as a result of thermal and mechanical effects when moving through the flow system. The main disadvantage of the system is the inability to use it as part of equipment for renal replacement therapy, as well as the inability to achieve sterility due to the fact that it does not provide for the use of disposable elements.

A device is known for extracorporeal blood purification by irradiation with ultraviolet light and plasma filtration [16]. The device consists of a double-circuit extracorporeal system, including peristaltic pumps, moving blood drawn from the femoral artery or vein in a closed circuit, a toxin inactivation unit in the form of a blood irradiator with ultraviolet radiation in the range 200-280 nm (UV radiation), consisting of plates and serpentine ultraviolet lamps, a hemoconcentrator unit (in the first circuit) and a plasma filtration unit (in the second circuit), as well as a diluent unit and a block of blood heating, which flows back into the vascular p the patient bed.

The disadvantages of this device include the complexity of the device in terms of technical implementation. The main disadvantage is the lack of a dialyzer (instead of it there is a filter for plasma filtration) as an important element of the body's detoxification system for renal failure, which obviously reduces the applicability of the device for the needs of renal replacement therapy; and the use of heating elements in the extracorporeal blood purification system sharply increases the risk of injury to blood elements as a result of thermal effects during the movement of blood through the flow system.

The closest analogue to the claimed technical solution is a device for joint hemodialysis and blood irradiation, adopted as a prototype [17]. The device consists of a closed extracorporeal blood supply line, which includes a blood irradiator connected in series by continuous radiation of the visible and near infrared range at a wavelength of 500-850 nm, a blood pump, a dialyzer with connected dialysis fluid inlet and outlet systems, and on the exhaust waste line of the dialysate, a pump is installed, after the dialyzer, a second blood irradiator is installed by continuous radiation of the visible and near infrared ranges for cheniya blood returned to the patient.

The disadvantages of the prototype device include the lack of arterial and venous pressure sensors, the absence of a heparin pump with a heparinized solution before introducing blood into the dialyzer, the lack of a pump on the hose of the dialysis solution inlet system, which makes it difficult to maintain the necessary speed of the dialysis solution moving through the dialyzer. The absence of an air trap in the device of the blood supply line, in which the blood is released from air bubbles, makes the use of the device unsafe for patients due to the risk of air embolism. In addition, the device does not use radiation effective for detoxification purposes - neither blue light, nor ultraviolet radiation, nor radiation in the range from 850 to 1300 nm, i.e. in the upper part of the so-called therapeutic transparency window, the use of which is effective for detoxifying the body [18-19]. The device has not taken technical solutions to prevent complications of infection or clogging of the fistulas at the points of collection and return of blood to the patient’s vascular bed. All this makes the device ineffective for detoxifying the body of patients with renal failure.

A common drawback of the above systems of detoxification in the extracorporeal circuit is the risk of complications, in particular, problems with vascular access. Common problems include infection, blockage of the vasculature due to the formation of a blood clot, as well as poor blood flow, including due to too viscous blood. These complications can make detoxification sessions difficult. Shunts and fistulas often develop thrombosis, infection, and aneurysms (which is most common with shunts). Fistula infection at the sites of blood collection and return is often complicated by sepsis and septic embolism, where Staphylococcus aureus (Staphylococcus aureus) is the predominant pathogen.

The objective of the invention is a qualitative improvement in the effectiveness of the treatment of acute and chronic renal failure, in particular, the prevention or reduction of the intensity of side effects and complications of detoxification of the body.

The problem is solved by the combined use of hemodialysis in combination with extracorporeal blood irradiation in the extracorporeal circuit to detoxify the body. The invention is implemented using a device containing in the extracorporeal circuit not only blood pumps and a dialyzer, but also a unit for preliminary irradiation of blood with electromagnetic radiation, a unit for irradiating blood passing through the dialyzer, units for pressure-induced irradiation of blood at the site of blood sampling and at the place of blood return to the patient, and also pressure sensors and air trap.

The proposed method combines the detoxification properties of hemodialysis and immunomodulating properties of extracorporeal blood irradiation and supravenous blood irradiation by performing them simultaneously. The combination of hemodialysis and EOK stimulates the body's immune system, improves erythrocytopoiesis, has an antihypoxic effect and is more effective than the separate application of extracorporeal detoxification methods, the general elimination of toxins from the body.

A method of detoxifying the body through the combined use of renal replacement therapy in combination with extracorporeal blood irradiation, including: blood sampling from a patient through an arterial needle or arterial fistula needle inserted into a peripheral artery or fistula, then passing blood through sterile, blood-conducting connecting hoses sequentially closed in a fluid circuit blood pump line, consisting of a roller perfusion pump, blood pressure sensor, the unit precedes irradiation of blood with electromagnetic radiation, where the blood moving along the extracorporeal circulation system is exposed to blue light and / or ultraviolet and / or laser radiation, then heparin is injected into the bloodstream to artificially reduce blood coagulation, and the blood enters the dialyzer with connected dialysate inlet and outlet blocks to it, and the dialysis solution enters from the dialysate inlet block by means of a pump, after which the blood enters the blood irradiation unit magnetic radiation passing through the dialyzer, where it is exposed to blue light and / or ultraviolet and / or laser radiation, then the blood passes through a venous pressure sensor and an air trap, and then the blood is returned to the patient in a peripheral vein through a venous needle or venous fistula needle. Then, blood sampling is again performed in the extracorporeal circle, and the detoxification procedure, including hemodialysis and irradiation, is repeatedly repeated, while the blood flow rate in the dialyzer varies and ranges from 150 to 450 ml / min. Blood irradiation is carried out in the blood line using two combined blood irradiation units, and the pressure in the blood line is measured at two points: before the blood pump (blood pressure) and before the patient returns blood (venous pressure). In addition, supravenous (external) blood irradiation with blue light and / or ultraviolet and / or laser radiation is carried out simultaneously in the area of blood sampling from the patient through an arterial needle or arterial fistula needle inserted into the peripheral artery or fistula, and in the area of blood return to the patient through venous or venous fistula needle inserted into a peripheral vein or fistula.

The method of detoxification of the body can be implemented by the combined use of renal replacement therapy in combination with extracorporeal blood irradiation, in which ultraviolet radiation is used as electromagnetic radiation. The wavelength of ultraviolet radiation in this case lies in the range from 200 nm to 280 nm (short-wave UV radiation), from 280 nm to 320 nm (medium-wave UV radiation) or from 320 to 380 nm (long-wave UV radiation).

The combined use of renal replacement therapy can be combined with extracorporeal blood irradiation, which uses blue light as electromagnetic radiation. In this case, the radiation wavelength lies in the range of 420-480 nm.

There may be a combined use of renal replacement therapy in combination with extracorporeal blood irradiation, in which laser radiation is used as electromagnetic radiation. In this case, the wavelength of laser radiation lies in the range from 850 to 1300 nm in the near infrared range, i.e. in the upper part of the so-called therapeutic transparency window [18-19].

The combined use of renal replacement therapy can be combined with extracorporeal blood irradiation, in which a helium-neon laser operating in the continuous mode of radiation generation is used as a source of electromagnetic radiation; a semiconductor laser operating in a continuous mode of radiation generation; a semiconductor laser operating in a pulsed mode of radiation generation; high-pressure microwell lamp operating in a pulsed mode; arc mercury tube lamp DRT-2-100; high-pressure xenon lamp with a small body of luminescence, operating in a pulsed mode; mercury-xenon high-pressure lamp with a small body of luminescence, operating in a pulsed mode; mercury lamp with blue phosphor; ultraviolet gas laser (excimer laser).

A device that implements a method of detoxifying the body by the combined use of renal replacement therapy in combination with extracorporeal blood irradiation includes an arterial needle or arterial fistula needle for collecting blood from a patient; sterile connecting hoses of a cyclic blood supply line, sequentially closed in a liquid circuit, a blood pump, consisting of a roller perfusion pump, a blood pressure sensor, a unit for preliminary irradiation of blood with electromagnetic radiation, a heparin pump, a dialyzer with connected inlet (intake) and dialysate outlet blocks, and an inlet dialysate is carried out using a pump, a block of blood irradiation passed through the dialyzer, a venous pressure sensor, an air trap, veins ozone or venous fistula needle for returning blood to the vascular bed of the patient; also, at the same time, supravenous (external) blood irradiation with blue light and / or ultraviolet and / or laser radiation is carried out simultaneously in the area of blood sampling from the patient through an arterial needle or arterial fistula needle inserted into the peripheral artery or fistula, and in the area of blood return to the patient through venous a needle or venous fistula needle inserted into a peripheral vein or fistula.

In this case, the preliminary blood irradiation unit is installed on the inlet channel for blood supply through the sterile connecting hoses of the blood supply line after the blood pump and blood pressure sensor, and the blood irradiation unit passing through the dialyzer is installed on the output channel for blood supply through the sterile connecting hoses of the blood supply line to venous pressure sensor and air trap. An air trap is an ultrasonic venous air trap or optical air detector.

In this case, extracorporeal blood irradiation is carried out in the blood line using the preliminary blood irradiation unit and the blood irradiation unit that passed through the dialyzer with electromagnetic radiation, where the blood is irradiated with blue light and / or ultraviolet and / or laser radiation; blood irradiated with electromagnetic radiation returns to the vascular bed of the patient; and supravenous blood irradiation is carried out by blue light and / or ultraviolet and / or laser radiation simultaneously in the area of blood sampling from the patient through an arterial needle or arterial fistula needle inserted into the peripheral artery or fistula, and in the area of blood return to the patient through a venous needle or venous fistula needle inserted into a peripheral vein or fistula.

Blocks of supravenous blood irradiation with blue light and / or ultraviolet and / or laser radiation can be combined into one block with two radiation sources.

Then the process is repeated several times within 2-4 hours. In this case, blood in the extracorporeal circuit must flow with a speed of at least 150 ml / min through the sterile connecting hoses of the blood supply line.

As a heparin pump, a syringe type pump or a peristaltic pump is used.

An ultraviolet lamp can be used as a source for irradiating blood.

Two LEDs are used as a source for irradiating blood, the maximum of the emission spectrum of one of which is located in the wavelength region of 265 nm, the other in the wavelength region of 290 nm.

Or a high-pressure microwell lamp operating in a pulsed mode. In this case, a high-pressure microwell lamp with a small luminescence body operating in a pulsed mode with a pulse frequency from 0 to 100 kHz is used as a radiation source.

Or a DRT-2-100 mercury lamp emitting in the range of 300-600 nm, together with a filter that allows you to select a narrow spectrum of blue light in the range of 430-470 nm.

Or a mercury lamp with a blue phosphor emitting in the wavelength range of 420-480 nm and a maximum of 435.5 nm.

An excimer laser with a wavelength of 313 nm and an energy of 0.3 mJ is used as a source of ultraviolet radiation.

Or a fluorescent erythema lamp with a maximum radiation at 313 nm.

Or an arc bactericidal lamp with a maximum radiation at 253.7 nm, which corresponds to the area of greatest bactericidal action.

A semiconductor laser operating in the pulsed mode of generating radiation with a wavelength of 850-900 nm, a pulse power of 2-15 W and a pulse duration of up to 1 ns is used as a laser radiation source.

There is a device in which a reusable flow cell made of a material transparent to ultraviolet radiation is used as a blood line in a blood irradiation unit. In this case, a reusable flow cell is made of quartz glass.

Or a flowing disposable polymer cuvette.

Or a flowing polymeric cell of repeated use.

The proposed method and device for detoxifying the body through the combined use of renal replacement therapy in combination with extracorporeal and supravenous irradiation of blood and a device for its implementation can effectively detoxify the body of patients suffering from renal failure and eliminate pathological substances from the patient’s blood that accumulate during renal failure, for due to hemodialysis, and due to irradiation of blood with blue light and / or ultraviolet, and / or a laser Radiation [21] achieves additional blood purification, a decrease in hypercoagulability, a decrease in blood viscosity and the risk of clumping of cells, resorption of microthrombi, metabolism is stimulated, and the level of oxygen in cells is normalized. This helps to prevent or reduce the intensity of side effects and complications during detoxification of the body by the proposed method and provides an improvement in the quality of life and its duration in patients with renal failure. The high quality of detoxification helps patients to increase the body's resistance, as well as to maintain a satisfactory state of health and performance for a long time and wait for kidney transplant surgery.

To minimize complications, in particular, problems with vascular access, as well as to avoid infection of the body at the sites of blood sampling and return to the patient, the proposed device implements irradiation of blood not only in the extracorporeal circuit, but also using a block for external blood irradiation, namely, of double blood irradiation (NLO) in the area of blood sampling from the patient, at the place where the arterial / venous fistula needle was introduced into the vascular bed of the patient. As a result of supravenous blood irradiation, a bactericidal and thrombolytic effect occurs, the local immune defense factor is stimulated at the puncture site. This avoids complications at the site of blood sampling. The NOC is carried out using a source of blue light and / or ultraviolet and / or laser radiation directed perpendicular to the irradiated blood vessel.

Due to the distinguishing features of the invention, a new higher result is obtained compared with the prototype, consisting in a qualitative improvement in the effectiveness of the treatment of acute and chronic renal failure, in particular, in preventing or reducing the intensity of side effects and complications of detoxification of the body. This is achieved through the combined use of two methods of detoxification of the body - hemodialysis in combination with extracorporeal blood irradiation in the extracorporeal circuit to detoxify the body, as well as additional pressure from the blood at the points of blood collection and return to the patient.

Graphic Images

In FIG. 1 is a block diagram of a device for detoxifying an organism, where 1 is an arterial needle or arterial fistula needle inserted into a peripheral artery or fistula for blood sampling from a patient; 2 - liquid circuit of the cyclic blood supply line, 3 - blood pressure sensor, 4 - blood pump, consisting of a roller perfusion pump, 5 - block of preliminary irradiation of blood with electromagnetic radiation, 6 - heparin pump, 7 - dialyzer, 8 - dialysate supply system, 9 - dialysate supply system pump, 10 - dialysate supplied, 11 - dialysate discharge line, 12 - spent dialysate, 13 - block of irradiation of blood passing through the dialyzer with electromagnetic radiation, 14 - air trap, 15 - sensor venous pressure, 16 - venous needle or venous fistula needle inserted into the peripheral vein or fistula to return blood to the vascular bed of the patient, 17 - pressure-induced irradiation of blood in the area of blood sampling from the patient at the injection site of the arterial fistula needle into the vascular bed of the patient, 18 is a block of supravenous blood irradiation in the area of returning blood to the patient's vascular bed at the injection site of a venous fistula needle.

A description of the operation of the device is illustrated in the figure. The general principle of the functioning of a device that implements a method of detoxifying the body through the combined use of renal replacement therapy in combination with extracorporeal blood irradiation is as follows: through the arterial needle or arterial fistula needle inserted into the peripheral artery or fistula (1), the blood from the patient enters the blood stream the trunk of the extracorporeal detoxification system of the body (2), flows through the blood pressure sensor (3), while the blood pressure sensor from measures blood pressure in the range from -150 mm Hg up to +300 mm Hg Then, with a roller perfusion pump (4), blood is transferred through sterile connecting hoses of the blood supply line, which are sequentially closed in a liquid circuit, where it is irradiated with blue light and / or ultraviolet and / or laser radiation using a preliminary irradiation unit (5), and then into the blood heparin enters through a heparin pump (6), after which blood with a given flow rate enters the mass transfer device - dialyzer (7), where blood is pumped through hollow fibers at a speed of 150 to 450 ml / min, and outside, fibers with walls of semipermeable membranes are washed with a dialysis solution (10) coming from the dialysate supply system (8) by means of a pump (9); spent dialysis fluid (12) enters the dialysate discharge system (11), and the blood passing through the dialyzer (7) is irradiated through the irradiation unit of the blood passing through the dialyzer with blue light and / or ultraviolet and / or laser radiation ( 13), then it enters the air trap (14), in which it is released from air bubbles, and then, having passed the venous pressure sensor (15), which measures venous pressure in the range from -50 mm Hg. up to +320 mm Hg, blood returns to the patient’s bloodstream, namely to the peripheral vein through a venous needle or venous fistula needle inserted into the peripheral vein or fistula (16). Through the block of pressure-induced blood irradiation in the area of blood sampling from the patient at the injection site of the arterial fistula needle into the patient’s vascular bed (17) and the block of pressure-induced blood irradiation in the area of blood return to the patient’s vascular bed at the injection site of the venous fistula needle (18), the sampling site is irradiated and blood return points with blue light and / or ultraviolet and / or laser radiation.

The detoxification procedure is repeated several times.

An example of using the invention

Patient N., 49 years old. With a diagnosis of chronic glomerulonephritis, hypertension, chronic renal failure stage III 2.5 years is on bicarbonate hemodialysis 3 times a week. Complaints of chills, malaise, high blood pressure. According to the analysis, leukocytosis and an increase in ESR were noted. Hemodialysis was performed for 3-4 hours. Vascular access - arteriovenous fistula. Blood flow rate 200 ml / min. In addition to regular hemodialysis sessions, she received blood irradiation with ultraviolet radiation by passing blood circulating in the extracorporeal circuit through a flowing quartz cuvette (10 sessions), as well as pressure-induced irradiation of blood in the vascular access area. Blood pressure laser irradiation was carried out in two versions: first, low-intensity laser radiation with a wavelength of 405 nm, a power of 1.5 mW with an exposure of 10-15 minutes, then the blood was irradiated with blue light (wavelength 420-480 nm, power 0.4 W s exposure up to 30 min).

The dynamics of body temperature were monitored, a general blood test was taken before and after the course.

As a result of the procedures, the following was noted: an improvement in the patient’s general well-being, normalization of body temperature, the disappearance of chills, a decrease in weakness, a decrease in ESR and leukocytosis was noted in the general blood test. Blood pressure after hemodialysis was stable. A pronounced effect was noted in the dynamics of the leukocyte intoxication index: already after the first procedures, the indicator decreased by more than 50%. The combined use of renal replacement therapy in combination with extracorporeal blood irradiation had a pronounced effect on hemorheology: the aggregation of red blood cells and platelets improved, and specific blood viscosity also tended to decrease.

Blood pressure laser irradiation led to a decrease in blood viscosity and an increase in erythrocyte elasticity, having a bactericidal and thrombolytic effect, and also stimulated the local immune defense factor at the puncture site, thereby avoiding complications at the sites of blood sampling and return.

It was recommended to continue the combined use of renal replacement therapy in combination with extracorporeal blood irradiation to prevent complications and if indicated.

The method of detoxifying the body through the combined use of renal replacement therapy in combination with extracorporeal blood irradiation has shown its applicability as significantly increasing the efficiency of the detoxification process of the body of patients with renal failure. Under the influence of electromagnetic radiation, which has a destructive effect on toxic metabolites and bacterial toxins, they were removed from the vascular bed and the toxic properties of blood decreased significantly.

Information sources

1. Mokeev I.N. Infusion-transfusion therapy: Handbook / M.: Publisher Mokeev, 1998. - 232 p.

2. Luzhnikov EA Clinical Toxicology / M.: Medicine, 1994. - 256 p.

3. N.A. Lopatkin, Yu.M. Lopukhin. Efferent methods in medicine / M .: Medicine, 1989. - 351 p.

4. Efferent therapy / Ed. Kostyuchenko A.L. - SPb., 2000 .-- 425 p.

5. Grinvald V.M., Kiselev B.L., Maksimov E.P., Khaitlin A.I. Equipment for artificial blood purification / Ed. Academician of RAMS V.A. Viktorova. - M .: CJSC "VNIIMP-VITA", 2002. - 230 p.

6. Artificial organs. Ed. IN AND. Shumakova. - M.: Medicine, 1990 .-- 272 p.

7. RF patent No. 2086264.

8. RF patent No. 2154499.

9. Dutkevich I.G. New methods of photohemotherapy / I.G. Dutkevich, A.V. Marchenko. St. Petersburg: Publishing House St. Petersburg MALO, 1993 .-- 45 p.

10. Dutkevich I.G. Extracorporeal photohemotherapy / I.G. Dutkevich, A.V. Marchenko, S.A. Sheaves. SPb .: "Science", 2006. - 400 p.

11. Karandashov V.I. Quantum therapy / V.I. Karandashov, E.B. Petukhov, V.S. Zrodnikov. M .: Medicine, 2004 .-- 336 p.

12. Karandashov V.I. Photohemotherapy (phototherapy) / V.I. Karandashov, E.B. Petukhov. M .: Medicine, 2001 .-- 392 p.

13. Karandashov V.I. Ultraviolet irradiation of blood / V.I. Karandashov, E.B. Petukhov. M .: Medicine, 1997 .-- 223 p.

14. Vetchinnikova O.N. Extracorporeal ultraviolet irradiation of blood in medicine: Monograph / O.N. Vetchinnikova, I.N. Piksin, A.N. Kalinin. - M.: Publisher E. Razumova, 2002 .-- 264 p.

15. RF patent №2012389.

16. US Patent No. 2006/0210424 A1, Sep.21, 2006.

17. US Patent No. 2007/0262020 A1, Nov. 15, 2007 - prototype.

18. Tuchin V.V. Lasers and fiber optics in biomedical research. - Saratov: Publishing House of the Saratov University, 1998. - 384 p.

19. Tuchin V. Tissue optics. Light scattering methods and instruments for medical diagnostic // Tutorial Texts, 2000, Vol. TT38. - SPIE Press. - 378 p.

20. US patent No. 6586172 B1, Jul. 1, 2003.

21. Alexandrov M.T. Laser clinical biophotometry (theory, experiment, practice). The world of biology and medicine / Publishing house "Technosphere", 2008. - 584 p.

Claims (14)

1. The method of detoxification of the body through the combined use of renal replacement therapy in combination with extracorporeal blood irradiation, including: blood sampling from a patient through an arterial needle or arterial fistula needle inserted into a peripheral artery or fistula, passing blood through the fluid circuit of the blood line through sterile connecting hoses , the passage of blood through a blood irradiator with electromagnetic radiation installed in front of a dialyzer connected to intake systems and issuing a dialysis solution, re-irradiating the blood with electromagnetic radiation, returning blood to the patient in a peripheral vein or fistula, characterized in that the pressure in the blood line is measured at two points: blood pressure in front of the blood pump and venous pressure before returning the blood to the patient, heparinization before the introduction of blood into the dialyzer, and the dialysis solution enters the dialyzer from the dialysate inlet system by means of a pump, and after re-irradiation In addition to blood collection, it enters the air trap; in addition, additional external blood irradiation with electromagnetic radiation is simultaneously carried out simultaneously in the area of blood sampling from the patient through an arterial needle or arterial fistula needle inserted into the peripheral artery or fistula, and in the area of blood return to the patient through a venous needle or venous fistula needle inserted into a peripheral vein or fistula. 2. The method according to p. 1, characterized in that as the electromagnetic radiation irradiating the blood, blue light, or ultraviolet radiation, or laser radiation is used. 3. The method according to p. 2, characterized in that the wavelength of the emission of blue light lies in the range of 420-480 nm. 4. The method according to p. 2, characterized in that the wavelength of the laser radiation lies in the range from 850 to 1300 nm near infrared. 5. The method according to p. 1, characterized in that the process of irradiating the blood with electromagnetic radiation is repeatedly repeated and carried out continuously for the duration of the detoxification session, but not less than 3 hours. 6. A device for detoxifying the body, including an arterial needle or arterial fistula needle, sterile connecting hoses of a cyclic blood supply line, a blood pump, a unit for preliminary irradiation of blood with electromagnetic radiation, a dialyzer with dialysate inlet and outlet connected to it, a unit for irradiating blood passing through the dialyzer with electromagnetic radiation, a venous needle or venous fistula needle, characterized in that before a blood pressure sensor is installed; after the air trap, a venous pressure sensor is installed before returning the blood to the patient; an heparin pump is installed in front of the dialyzer, the dialysate is supplied from the dialysate inlet to the dialyzer by means of a pump, an air trap is installed after the blood irradiation unit that passed the dialyzer, and in the area of blood sampling from the patient at the injection site of the arterial fistula needle into the patient’s vascular bed and into Two blocks of pressure-induced irradiation of blood with electromagnetic radiation are installed in the area of returning blood to the patient’s vascular bed at the injection site of the venous fistula needle. 7. The device according to claim 6, characterized in that an ultrasonic venous air trap or an optical air detector is used as an air trap. 8. The device according to claim 6, characterized in that the syringe type pump or peristaltic pump is used as the heparin pump. 9. The device according to p. 6, characterized in that two LEDs are used as a source for irradiating blood with electromagnetic radiation. 10. The device according to claim 6, characterized in that the DRT-2-100 mercury lamp is used as a source of electromagnetic radiation in conjunction with a filter, which makes it possible to isolate a narrow spectrum of blue light in the range of 430-470 nm or a mercury lamp with a blue phosphor emitting in the wavelength range of 420-480 nm and a maximum of 435.5 nm. 11. The device according to p. 6, characterized in that as the source of electromagnetic radiation using laser radiation through a semiconductor laser. 12. The device according to claim 6, characterized in that a multiple-use flow cell made of a material transparent to ultraviolet radiation or a single-use polymer flow cell is used as a blood line in the blood irradiation unit. 13. The device according to claim 6, characterized in that ultraviolet radiation is used as an electromagnetic radiation source by means of an excimer laser with a wavelength of 313 nm and an energy of 0.3 mJ or an erythema fluorescent lamp with a radiation maximum of 313 nm or an arc bactericidal lamp with a maximum radiation at 253.7 nm. 14. The device according to p. 6, characterized in that the blocks of bi-directional irradiation of blood with electromagnetic radiation are combined in one block with two radiation sources.