RU1818101C - Method for detoxication of organism when poisoned with soporifics and psychotropic - Google Patents

Abstract

The invention relates to medicine and can be used in the treatment of acute hypnotic poisoning in psychotropic drugs. The purpose of the invention is to increase the effectiveness of detoxification by increasing the intensity of elimination of toxic substances from the body, reducing the duration of the coma and the likelihood of developing clinical complications. The goal is achieved in that the blood of the patient for hemosorption is treated with ultraviolet rays with a radiation intensity of 3.1-3.3 J / min. 2 tab.

Description

- The invention relates to medicine and can be used in the treatment of acute poisoning with barbiturates and other sleeping pills and psychotropic drugs. ,, The purpose of the invention is to increase the intensity of the removal of toxic substances from the body, reduce the duration of coma and the likelihood of developing clinical complications.

The method is carried out as follows.

In order to conduct a GS and UFOK in the lower third arm, a Scribner arteriovenous shunt is placed between the radial artery and one of the superficial veins. Then, heparinization of blood is carried out at the rate of 350-400 units. heparin per 1 kg of patient body weight. After that, a 150 cm3 detoxifier column (SKT-ba sorbent) is included in the shunt connector, for which 2 blood lines are used, which serve to supply blood from the artery to the column and to divert it from the column into a vein. Then, the supply line is treated with alcohol, 2 clamps are applied to it at a distance of 3-4 cm from each other, and the line between them is cut. In the resulting connector, a quartz cuvette from the serial device UFOK MD-73M Isolde of the State Optical Institute is strengthened by the end cannula. The apparatus is equipped with a UV irradiator (DRB-8 mercury-quartz lamp with a predominant wavelength of 254 nm), and the area of the cell, which is open for irradiation (maximum 35 cm), is regulated by a special opaque curtain. UFOK is started after the UFOK apparatus returns to operating mode (10 minutes after the irradiator is turned on). Then, using a pump, blood is podoo

00

about

Shelter in a column with a sorbent with a volumetric flow rate of 70-150 ml / min. Passing through the supply section of the blood line, the blood is irradiated, and then in the column with the sorbent it is cleaned of toxic substances and returned to the patient’s bloodstream. For 1 GS session, 2 columns are used during their alternate operation for 30 min each with a total perfusion volume of 4.2–9 L of blood.

The effectiveness of detoxification in the process of HS is evaluated by the indicator of elimination of a toxic substance characterizing the sorption capacity of the apparatus at a given time.

3 (t) CBH (yhF-10o% ..

where E (t) is an indicator of elimination;

CBx (t) - concentration of toxic substance: at the entrance to the detoxifier column;

SvyhDO- concentration of toxic substance at the outlet of the column.

The energy of UV radiation is calculated by the formula

 i Anp t ,, where Qt is the radiation energy (J);

EI is the surface radiation flux density in the plane of the cell, W / m2, equal to 24.6 for a given source;

APr — cell area, open for irradiation, or receiver area, m;

t is the irradiation time, s.

In order to standardize the conditions for obtaining data on the comparative sorption of target metabolites confirming a positive effect, we first analyzed the effectiveness of UFOs when it was carried out during the operation of only the 2nd column.

Taking into account that EI and t remained constant, the dose of ultraviolet radiation was calculated by the area open for irradiation (APR). The studies were carried out with an APR of 11.7 cm2 (50.2 J. or 1.7 J / min), 17.5 (75.1; 2.5), 20.4 (87.6; 2.9), 21 , 8 (93.6; 3.1), 22.6 (97.0; 3.2) 24.8 (106.4; 3.5), 26.2 (112.4; 3.7), and 29.2 cm2 (125.3 J, or 4.2 J / min).

The level of toxic substances - ATP and medium molecules (SM) in the body’s biological media was determined by known methods, the content of barbiturates and SM in the blood was determined quantitatively, and amitriptyline, phenothiazines and benzodiazepines in the urine qualitatively.

Example 1. Patient P., 34 years old, was admitted 05.22.90, 3 hours before admission, he took a mixture of psychotropic drugs. Upon admission, a coma that was stopped by respiratory failure. Level

barbiturates in the blood upon admission 34 μg / ml, benzdiazepines were found in the urine. 4 hours after admission, a GS session was conducted with a volumetric flow rate of 100

ml / min in combination with UFOK during the work of the 2nd column. APR was 21.8 cm2 (93.6 J; 3.1 J / min). After GS and UFOK according to the proposed method, a positive neurological dynamics was noted, and after 12.4

h after admission, the patient emerged from a coma. The elimination of barbiturates during the operation of the 1st column was 16.2 + 1.6%, and during the operation of the 2nd column (against the background of the UFOK) - 28.8 ± 9.6%, i.e. increased by 1.8 times, benzdiazepines in the urine after HS and UFOK - in the tracks. Discharged after 9 days in satisfactory condition.

PRI me R 2. Patient T., 28 years old, was admitted 30.05.90, 4-5 hours before admission received

inside a mixture of sleeping pills and psychotropic

 drugs, on admission. - coma

state with sharp suppression of reflexes.

Barbiturates found in the blood - 20 mcg / ml,

traces of benzdiazepines in urine. On the background

conservative therapy - deepening coma, in connection with which the commencement of GS and UFOK by the proposed method has been started. Blood flow rate of 70 ml / min, APR 22.6 cm2 (97.0 J or 3.2 J / min). After HS

sustained positive dynamics. The coma duration was 10.5 hours. Elimination of barbiturates in the 1st column was 45.5 ± 15.1%, and in the 2nd - 83.3 + 16.7%, i.e. as a result of GS and UFOKon

increased by 1.8 times (by 83.1%). The course of the disease without complications. Discharged on the 9th day.

Example 3. Patient K., 26 years old, was admitted on 01/19/90. 10 hours before admission, sodium etaminol was presumably taken. Upon admission, a coma with respiratory failure. Barbiturates, 16 mcg / ml, were found in the blood. Due to the failure of conservative therapy and the presence of respiratory complications

GS was performed in combination with UFOK at the entrance to the 2nd column with an APR of 23.3 cm2 (100 J or 3.3 J / min), the volumetric blood flow rate was 100 ml / min. After HS - a significant improvement in the patient's condition with a noticeable

revitalizing all types of reflexes. The elimination of barbiturates during the operation of the 1st column was 30.5 + 3.2%, against the background of the work of the 2nd column and UFOK - 42.4 ± 14.9%, or 38.3% higher. The coma lasted 8.5 hours. Later, right-sided lower lobar pneumonia joined, mainly associated with prolonged exposure and in the body, which was favorable and resolved by 13 days from the moment of hospitalization of the patient.

In general, the effect of the proposed method of treatment on the detoxification process is as follows (Table 1).

As can be seen from the table. 1, when UFOK is used in the optimal mode, the elimination of barbiturates during the HS process is almost doubled, while when using UFOK doses higher or lower than optimal, it decreases markedly.

The rate of sorption of SM by the 1st and 2nd columns with UFOK in the optimal mode and at values exceeding it is maintained (elimination within 26.0 + 3.6- 28.1 +3.3%), and against the background In FD, K below a minimum decreases markedly (by 23.7%). :

When carrying out UFOK simultaneously with GS with the location of the UFOK apparatus after the detoxifier column, at Apr 23.3 cm2 (100 J or 3.3 J / min), elimination of barbiturates by the 1st column averaged 53%. and 2nd - 24%, i.e. during UV irradiation was more than 2 times less.

When conducting UFOK with an intensity of 3.2 J / min throughout the entire HS (during the operation of both columns) also

there was a high degree of elimination of the toxic substance (from 67.6 to 89.5%) during the operation of both the 1st and 2nd columns, this was accompanied by an improvement in treatment results.

In general, the effectiveness of the proposed method is confirmed by the following data (table. 2) ......

As can be seen from the table. 2, an improvement in treatment results is accompanied by a reduction in the coma, a significant decrease in mortality (1.5 times) and the frequency of pneumonia.

b.

Formulas of the invention

The method of detoxification of the body in case of poisoning with hypnotics and psychotropic drugs by carrying out hemosorption and ultraviolet irradiation of the blood, and, moreover, with the aim of increasing the effectiveness of detoxification by reducing the duration of the coma and the likelihood of development clinical complications, the patient’s blood is treated with ultraviolet rays with a radiation intensity of 3.1-3.3 J / min before hemosorption.

Table The effect of UFOK on the elimination of barbiturates in the process of HS

Note: - p 0.05; - 0.05 p 0.1

Comparative data on the treatment of patients with acute ATP poisoning by the prototype method and the claimed method

Table 2