RU1811858C - Method of detoxification of organism - Google Patents

Abstract

The invention relates to medicine and can be used in the treatment of diseases accompanied by intoxication of the body. The aim of the invention is to increase the therapeutic effect of the method. The goal is achieved. that the plasmapheresis procedure is performed by port-portal access. 3 ill.

Description

The invention relates to medicine, in particular to efferent methods of treatment in surgery.

The aim of the invention is to increase the effectiveness of detoxification.

Figure 1 shows the scheme of introducing a double-lumen catheter into the portal vein and connecting an extracorporeal circuit to it, where 1 is the portal vein, 2 is the umbilical vein, 3 is the double-lumen catheter, 4 is the device for the end part of the catheter, 5 are the gaps for blood sampling, 6 - clearance for blood return, 7 - roller pumps, 8 - plasma filter, 9 - column for washing red blood cells, 10 - air trap; Figure 2 shows the dynamics of the hepatoportic blood flow during the process; in Fig. 3 - dynamics of the splenic blood flow. . -. ..: ...:.;. ... Blood supply to the liver and spleen was evaluated according to the 1st derivative of the tetrapolar rheohepatogram and replenogram, where A. is the amplitude of the differential rheogram characterizing. a drop in resistance due to blood flow in the arteries, 1 - the initial blood supply to the liver and spleen, 2 - the reaction of portal blood flow to fill the extracorporeal circuit, 3 - a change in hepatoportal blood flow during blood return, 4-blood supply to the liver and the state of outflow from the spleen with the corrected: high-speed regime of filtration and blood return, 5 - blood supply to the liver and spleen after the end of the procedure, 6 after 1 day, 7 after 2 days.

The method is carried out as follows.

During the paws of the rotomia (or extraperitoneal access), the umbilical vein 2 is blown up and a double-lumen catheter 3 is inserted through it into the portal 1, blood is taken through one of its lumens 5, and blood is taken through the other 6 - after detoxification and xigenation by cascade filtration . In response to filling the circuit, there is a decrease in portal inflow to the liver with a constant hepatic and the outflow through the splenic vein is facilitated due to a decrease in portal pressure (Fig. 2.2). Blood return is accompanied by a reflex narrowing of the arterioles of the liver, which progresses in response to increased wall pressure in the portal vein

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and leads to the disclosure of arteriovenous anastomoses, while the reographic deposition of blood in the venous system of the liver and the difficulty in outflow from the spleen are recorded. This hemodynamic situation requires a decrease in return rate or an increase in filtration rate. Correction of these speeds leads to the optimal ratio between inflow and outflow in the hepatoportal zone. Continuation of plasmapherosis is carried out in the speed mode corrected in this way. After the end of the plasmapheresis session, an improvement in blood supply to the liver, an increase in the elasticity of the arteries, normalization of the tone of the arterioles, and emptying of the venous sinuses of the spleen are observed.

Thus, the regional portal portal perfusion of the liver with detoxified, oxygenated blood in the optimal hydro-hemodynamic mode, empirically selected by varying the ratio of filtration rates and blood return, provides a steady improvement in blood supply not only to the liver, but also to the sylvenum. Detoxification of portal blood maximally saturated with toxins helps to deepen the detoxification effect.,

Example p. Patient S. 23 years old, information security No. 5547, was transferred on April 24, 89 to the department of abdominal surgery of MONIKI named after M.F. Vladimirsky of. Central District Hospital of the Moscow Region at 9. day after appendectomy with D-z: Acute destructive appendicitis, diffuse purulent perititis. Small bowel obstruction. Upon receipt of a complaint of intense pain in the abdomen, nausea, vomiting, thirst, shortness of breath.

The patient's condition at admission is extremely severe. Confused Consciousness. The skin is pale, cold, clammy sweat. - Respiration is frequent, shallow, with auscultation weakened, in the posterior-lower parts of the lungs - wet rales, chd- 36 D 1 mim. Heart sounds are muffled, cardiac activity is rhythmic, etc. 133 in 1 min. , Pulse rhythmic, intense, 133 in 1 min. HELL 150/100 mm Hg The tongue is dry, coated with a thick coating. Abdominal breathing is absent. The muscles of the anterior abdominal wall are visually tensed, the abdomen is swollen, and peristaltic jesters are not heard. Percussion and palpation are sharply painful, with palpation, muscle tension of the anterior abdominal wall is noted, symptoms of peritoneal irritation are pronounced in all parts of the abdomen. The lump is not enlarged. The spleen is palpated. There was no chair. Gases for waste t. Diuresis per day 900 ml.

Body temperature 38.6. Laboratory and biochemical data are characteristic of an acute inflammatory process. On the roentgenogram, congestive pulmonary events, typeventional phenomena, left disk-like atelectasis in the basal area with the possible attachment of inflammatory

pleuro-pulmonary changes. According to tetrapolar rheography, a significant decrease in hemodynamic activity with adaptive redistribution of blood flow according to the type of centralization - deposition of blood in the venous vessels of the lungs against the background of peripheral vasoconstriction and cerebral vasodilatase, signs of pulmonary hypertension,. venous hyperemia of the abdominal cavity and spleen, ischemia of the liver with venous congestion; severe functional state of the cardiovascular system.

The patient underwent rolaparotomy, separation of adhesions, nasointestinal intubation, sanation, and drainage of the abdominal cavity.

During the operation, the umbilical vein was throttled, through which a double-lumen catheter was inserted into the portal vein: For the purpose of detoxification, 04/25/89, port-port hemosorption was performed, complicated by the perfusion reaction - pronounced chills, muscle fibrils, hyperdynamic vascular crisis

an attack of paroxysmal supraventricular tachycardia with a heart rate of 200 in 1 min., a rise in blood pressure to 180/110 mm Hg. The perfusion reaction was stopped by iv administration of calcium chloride, diphenhydramine. After

at the end of the hemosorption session, slight chills persisted for 1.5 hours. In the next 3 days, the patient's condition without improvement, despite the decrease in toxicity of serum red blood serum and the concentration of medium-molecular compounds .;

04/28/89 The method of extracorporeal detoxification of the body was carried out. The volume of exfused plasma was 1200 ml.

The dynamics of blood supply to the liver, see

Fig.Z. No perfusion reactions were observed. Blood pressure, central and regional hemodynamics are stable during the β-procedure. Within 1 day after the procedure, the patient's condition improved significantly, abdominal pain decreased, nausea, vomiting, drowsiness disappeared; the patient became more active, slept calmly at night, increased appetite, independent stools - the concentration of medium molecular toxins decreased from 0.73 to 0.34, toxicity

blood serum decreased by 43%, the partial pressure of oxygen increased from 87.0 to 120.0.

The state of hemodynamics has improved. The functional state indicator increased from 0.3 to 0.9, stroke volume increased from 32 ml to 55 ml, minute volume increased from 4.2 l to 5.3 l, its cerebral fraction decreased from 23% to 15%, adaptive hyperfusion of the brain was replaced by normal cerebral blood flow of 795 ml / min. Peripheral circulation improved from 0.8 ml / min per 100 cm3 of tissue to 1.5 ml / min per 100 cm3. systolic pressure in the pulmonary artery decreased from 48 mm to 29 mmHg pulmonary blood flow increased from 0.35 ml / 100 cm3 to 1.1 ml / 10 cm3 tissue. The vascular tone normalized, and the deposition of blood in the venous system of the lungs, abdominal cavity and spleen ceased. Myocardial condition improved by ECG data, heart rate decreased to 92 in 1 min. on the 1st day after plasmapheresis and up to 85. in 1 min. - in the following. After 2 days, the radiological picture of the lungs returned to normal. A significant improvement in blood supply to the liver, noted on the 1st day after plasmapheresis (Fig.2, 6) and significantly distinguishing it from other methods of detoxification, was less pronounced on the 2nd te day (Fig.2.7) in connection with the marked simultaneous an increase in the level of mean serum toxins in the blood serum, which again increased the functional

- load on the liver. However, this decrease in hepatic and portal blood flow was less pronounced than in patients of the same degree of prevalence and severity of peritonitis observed after he conducted methods of detoxifying the body with traditional vascular accesses. Unlike the latter, in patient C, stable hepatic and portal circuits with an optimal ratio of inflow and outflow were maintained for 3.5 weeks, the clinical condition continued to improve, which did not require a repeat of the Method .... In cases of other vascular accesses on the 2nd day after plasmapheresis, not only biochemical, but also clinical manifestations of a repeated wave were noted

endotoxemia due to leaching of toxins from tissue depots due to the draining function of plasmapheresis, as well as the production of toxins. When applying our proposed Method ... 1, this function also took place. But the increase in the concentration of toxins in the blood after their entry from the depot into the vascular bed did not manifest itself clinically, because endotoxin

effects on organs and systems were weakened by the mobilized detoxifying function of the liver and spleen, the functional reserves of which were replenished with a single method.

Subsequently, the patient received the generally accepted complex therapy of diffuse purulent peritonitis, including HBO, antibiotic therapy and infusion treatment. The patient was discharged to

satisfactory condition.

The method of extracorporeal detoxification of the body was carried out in 8 patients in the terminal phase of a diffuse purulent. peritonitis. Compared to the ways

carried out in the control group of patients using other vascular accesses, after the method, significant advantages in the dynamics of the hepatic and splenic

blood flow, the functional state of the cardiovascular system and the degree of improvement of the clinical results of the treatment. In one case, biochemically recorded relapses of endotoxemia are not pro-

.. It was clinically instrumental in diagnosing indications of a repeat detoxification.

Thus, the use of the method of extracorporeal detoxification of the body helps to mobilize the natural detoxification reserves of the liver and spleen, which improves the treatment results, and the effect of extracorporeal detoxification is potentiated.

Claims (1)

The claims The way to detoxify the body by conducting an exchange cascade filter; plasmapheresis, characterized in that, in order to increase the therapeutic effect, plasmapheresis is carried out port-portal access.