RU2078595C1 - Method for treatment of hepatic insufficiency - Google Patents

Abstract

FIELD: medicine; surgery, particularly, treatment of hepatic insufficiency. SUBSTANCE: method involves cannulating umbilical vein of patient suffered from hepatic insufficiency followed by puncture of peripheral vein and connection to device for extracorporeal ultraviolet irradiation of blood; then blood sample on the basis of 2 ml/kg is extracted from vein using device roller pump and transported to vessel filled with blood-stabilizing solution and irradiated by ultraviolet at the time; extracted blood is returned in liver portal system through cannulated umbilical vein and irradiated by ultraviolet once again. EFFECT: higher efficiency of liver disordered function recovery.

Description

 The invention relates to medicine, mainly to surgery, and can be used to treat patients with liver failure syndrome.

 The development of liver failure is one of the most serious complications arising from shock, blood loss, burn disease, in the postoperative period, as well as with infectious and toxic liver lesions (O. B. Milonov et al. Postoperative complications and dangers in abdominal surgery. M. Medicine , 1990, p. 336 339). In the postoperative period, liver failure most often develops after operations on the organs of the hepatopancreatoduodenal zone, after operations on peritonitis, bowel obstruction, severe combined injuries, as well as purulent-septic and blood transfusion complications and drug illness. The main reason for its development is liver ischemia, dystrophic and necrobiotic changes in hepatocytes as a result of decreased organ blood flow, exo- and endotoxicosis, impaired passage of bile (RN Lebedeva. Complications in the circulatory system after surgical interventions. M. Medicine, 1979, p . 92 95; II Shimanko et al. Principles and methods of treatment of acute hepatic-renal failure. Anestesiol. Resuscitation, 1986, N 5, p. 10 14).

 Treatment of patients with liver failure is a very difficult task. It includes the use of a complex of conservative drugs called "basic therapy" and surgical (special) treatment methods (E.I. Halperin et al. Liver failure. M. Medicine, 1978, p. 186 199).

 The main areas of treatment for patients with acute liver failure are the maintenance of vital organs (heart, lungs, kidneys, liver, brain), versatile detoxification therapy, correction of blood coagulation disorders, microcirculation and the immune system, prevention of infectious complications, rational oral and parenteral nutrition stimulation of regenerative processes in the liver to restore the function of its cells to the stage of compensation of impaired functions (M. S. Margulis and . Oavt Modern Aspects of intensive treatment of acute liver failure, complicated encephalopathy -. Reanimatol Anesthesiology 1989, N 1, 60 64).... From this perspective, the use of extracorporeal ultraviolet irradiation of autologous blood with a complex of therapeutic effects on the human body is pathogenetically substantiated: detoxifying, vasodilating, improving microcirculation, oxygen saturation and rheological properties of the blood, stimulating regeneration and erythropoiesis, and also possessing anti-inflammatory L. and antioxidant and anti-inflammatory L. V. Potashov, R.V. Cheminava, Ultraviolet Irradiation of Own Blood.Vest.Hir. 1982, No. 6, p. 130 133; B.S. Vikhre et al. Immunostimulating and antioxidant effect of autotransfusions of UV-irradiated blood during thermal burns. In the book Mechanisms of the effect of blood irradiated by ultraviolet rays on the human and animal body. L. Nauka, 1986. p. 39 49; GP Deryagina. Influence UV-irradiated blood on the state of the blood coagulation system and fibrinolysis in patients with unstable angina pectoris, ibid., P. 85 96; AE Gromov et al. Effect of reinfusion of autologous blood irradiated with UV rays on the rheological properties of blood. In the same place, with. 207,211; S.S. Chubenko et al. The use of ultraviolet irradiation of autologous blood in patients with a gastroenterological profile. On Sat Effective methods in medicine, part 2, Izhevsk, 1992, p. 144).

 As a prototype of the claimed invention taken "Method for the treatment of non-infectious liver diseases complicated by jaundice", protected by A.S. N 1174042 (bull. N 31, 1985). The essence of the method, selected as a prototype, is that in order to restore the secretory-excretory function of the liver, patients are injected with single-donor plasma at the rate of 1 ml per 1 kg of body weight at a rate of 30 40 drops per minute twice with an interval of 2 to 3 weeks, previously irradiated with ultraviolet rays with a length of 237.7 nm for 1.5 3 minutes

The specified method of treatment has several disadvantages:
1 photomodified plasma reinfusion is performed in a peripheral bath, which reduces its therapeutic effect on the liver, since the plasma is diluted in the patient’s blood;
donor plasma is exposed to ultraviolet radiation, the therapeutic spectrum of which is much smaller than blood, since under the influence of ultraviolet rays only the plasma proteins undergo photochemical changes.

 The noted deficiencies can be eliminated in the claimed solution. The aim of the present invention is to provide a stimulating effect directly on the liver cells for the fastest restoration of its functions. This object is achieved by the fact that patients with hepatic insufficiency carry out intraportal administration of autologous blood subjected to extracorporeal ultraviolet irradiation (EUVF).

A detailed description of the method and examples of its implementation
In patients with hepatic insufficiency as a result of traumatic or hemorrhagic shock, or severe postoperative period, the umbilical vein is recanalized and a special catheter cannulated for the umbilical vein cannulation, for example, umbilical catheter performed by UHL 4.2 GOST 15150-69, and filled heparin solution to prevent thrombosis. Then a peripheral vein is punctured, for example, an ulnar vein, or a catheter is inserted into the subclavian vein and the Isolde-MD-73M apparatus is connected to it. Using a roller pump of this apparatus, the patient’s blood is taken at the rate of 2 ml / kg, it is pumped through a quartz cell at a speed of 16 ml / min. above a source of ultraviolet rays with a wavelength of 254 nm and collected in a container with a blood-stabilizing solution, for example, "Glugin", then the collected blood is injected into the portal system of the liver through a cannulated umbilical vein, subjected to repeated ultraviolet irradiation when passing through a quartz cell. Sessions of EUF autologous blood with intraportal administration after irradiation are carried out 1 2 days before clinical improvement of the condition of patients and normalization of blood biochemical parameters: proteins, bilirubin, urea, prothrombin index, fibrinogen, on average 1 6 sessions.

Example 1. B-naya V-o N.N. 67 years old (source. Bol. N 2985) was admitted to the surgical department of the Rostov BSMP N 1 named. ON. Semashko with a diagnosis; exacerbation of chronic cholecystitis. After preoperative preparation and examination on 05.11.92, the operation was performed cholecystectomy, choledocholithotomy, drainage of the common bile duct according to Vishnevsky, drainage of the subhepatic space according to Redon. During the operation, 5 stones with a diameter of 4-6 mm and putty-like masses were removed from the common bile duct. Bile flowing out of the common bile duct had a turbid character with a large number of flakes of fibrin, which indicated the occurrence of cholangitis. For intraportal administration of drugs, the umbilical vein is cannulated. A heparin solution was introduced into the lumen of the catheter held in the umbilical vein to prevent thrombosis. After surgery, the patient's condition for 6 days was severe. There was a high body temperature, nausea, vomiting, pain in the right hypochondrium, signs of jaundice appeared: icteric sclera, increased total blood bilirubin to 47 μmol / l, blood urea increased to 17 mmol / l, transaminases 0.3 μmol / l, total proteins 64 g / l In the blood test: red blood cells 4.0 • 10 ¹² / l, hemoglobin 125 g / l, leukocytes 9.5 • 10 ⁹ / l, neutrophils: stabs 8.5% segmented 67% lymphocytes 20% monocytes 4% Drainage from the common bile duct 11.11.92, about 70 ml of turbid bile was released. These phenomena are regarded as manifestations of liver failure. In this regard, the patient 12.11.92, performed a session of EUF autologous blood at a rate of 2 ml / kg. In this case, blood was taken from the right ulnar vein, twice irradiated with ultraviolet rays with a wavelength of 254 nm using an Isolda-MD-73M apparatus with a flow rate through a quartz cuvette of 16 ml / min and the patient was returned to the body through a cannulated umbilical vein into the portal system the liver. The patient at the same time felt the appearance of heat in the liver. The next day, the condition improved dramatically. The pulse became 78 in 1 min, the body temperature dropped to 36.7 ^o C, the abdomen became soft, slightly painful in the area of operation. After 2 days, jaundice began to decline, and blood urea levels gradually returned to normal. In satisfactory condition on 11/19/92, the patient was discharged for outpatient treatment. Blood tests at discharge: red blood cells 4.2 • 10 ¹² / l, hemoglobin 130 g / l, white blood cells 8.4 • 10 ⁹ / l, neutrophils: stab 3% segmented 57% lymphocytes 34% monocytes 5% total bilirubin 7 ml mol / l, transaminases 0.8 μmol / l, amylase 54 g / l.

Example 2. Bnoy N-about VV 15 years old (source. Bol. N 3271) entered the surgical department of the Rostov BSMP N 1 named. ON. Semashko 11/28/92, about gangrenous-perforated purulent appendicitis, diffuse purulent peritonitis. On the same day, the patient underwent surgery laparatomy, appendectomy, drainage of the abdominal cavity, cannulation of the umbilical vein. After the operation, the patient's condition remained serious. November 29, 1992, a hemosorption session was performed. However, the patient's condition did not improve. The next day, there were signs of liver failure: ictericity of the skin and sclera, deterioration in general condition, total bilirubin increased to 88.0 μmol / l, direct bilirubin to 35.0 μmol / l, total proteins decreased to 43 w / l, in the general analysis blood: erythrocytes 3.7 • 10 ¹² / l, hemoglobin 108 g / l, leukocytes 9.9 • 10 ⁹ / l, neutrophils: stab 30% segmented 59% lymphocytes 7% monocytes 4% On examination, the patient’s condition is very serious, pulse 112 in 1 min, blood pressure 115/60 mm RT. Art. breathing 26 in 1 min, the abdomen is swollen, peristalsis is not heard, the gases do not go away. 11.30.92, the session was performed EUVA autoblood apparatus "Isolda-MD-73M" at the rate of 2 ml / kg Blood was taken from the left ulnar vein, pumped through a quartz cuvette at a speed of 16 ml / min. while irradiating with ultraviolet rays with a wavelength of 254 nm, and collected in a vial with glugitsir, and then after repeated irradiation was introduced intraportally through a catheter in the umbilical vein. After 1 day, the patient's condition improved, and after 2 days it became of moderate severity: pulse 88 in 1 min, blood pressure 110/70 mm RT. Art. Significantly reduced the effects of intoxication. In blood tests: erythrocytes 3.8 • 10 ¹² / l, hemoglobin 112 g / l, white blood cells 13.8 • 10 ⁹ / l, neutrophils: young 1% stab 26% segmented 62% lymphocytes 10% monocytes 1% total bilirubin 30 μmol / L, direct bilirubin 8 μmol / L, total proteins 61 g / L. After 2 days, the patient had an independent chair, the patient was allowed to eat through the mouth. Further treatment was carried out in connection with suppuration of the surgical wound, after which he was discharged from the hospital.

The inventive method of testing for 16 patients. There were no complications in connection with its use. Compared with the prototype of the proposed method has the following advantages:
1 has a diverse therapeutic effect on the liver, which stimulates the early restoration of its functions;
2 reinfusion of photomodified autologous blood occurs directly into the portal system of the liver.

Claims (1)

 A method of treating liver failure, including the introduction of blood components at the rate of 2 mg / kg, irradiated with ultraviolet rays with a wavelength of 254 nm, characterized in that the peripheral venous autologous blood is irradiated at a blood flow rate through the quartz cuvette of 15 ml / min followed by reinfusion into the portal liver system through cannulated umbilical vein.