RU2170106C1 - Method for applying discrete plasmapheresis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves separating autoblood in erythrocytes and plasma by centrifuging, removing plasma and returning the erythrocytes to the patient organism in intravenous dropping way. Erythrocytes are mixed with solution containing polyvinyl pyrrolidone in 1:1 proportion, incubated at temperature of 36.9-37.1 C during 15-20 min. The centrifugation is repeated and supernatant fluid is removed. The washed erythrocytes are diluted with physiological salt solution in 2:1 proportion. EFFECT: enhanced effectiveness of treatment; reduced amount of blood taken and donor blood introduced.

Description

 The invention relates to medicine and can be used in transfusiology and intensive care.

 There is a method of detoxification using discrete plasmapheresis, which consists in a partial 2000-3000 ml exfusion of the patient’s blood, its separation into cells and plasma by centrifugation, separation and removal of toxic plasma with the return of blood cells to the patient intravenously (see Lopatkin N.A., Lopukhin Yu. .M. Efferent methods in medicine (theoretical and clinical aspects of extracorporeal treatment methods). - M .: Medicine, 1989. - C. 268-269).

 A disadvantage of the known method of detoxification is the occurrence of hypo- and dysproteinemia in severe purulent-septic patients due to the large volume of the removed plasma and inadequate replacement by donor plasma.

 The technical effect consists in detoxification and plasma-saving actions, which allows to reduce the amount of blood taken and, therefore, to reduce the amount of substitution by donor plasma and drugs. This is especially important in patients with severe violations of the adaptive-reparative processes, multiple organ failure, immunodeficiency due to a decrease in blood supply to internal organs in the presence of complications, background and concomitant diseases, as well as deficiency of donor media and protein preparations.

The essence is that in the method of discrete plasmapheresis by separating autologous blood by centrifugation into red blood cells and plasma, separation, removal of plasma and return of red blood cells to the patient in / in drip; erythrocytes are mixed with a solution containing polyvinylpyrrolidone (for example, with haemodesis) in a ratio of 1: 1, incubated at a temperature of 36.9-37.1 ^o C for 15-20 minutes, then centrifuged again at 2700-2800 rpm for 10-15 minutes, the supernatant is removed, and the washed red blood cells are diluted with saline in a ratio of 2: 1.

The method is as follows. Produce venipuncture. After a short pre-exfusion preparation in the amount of intravenous drip infusion, 1000-800 ml of Ringer's solution or physiological saline with 80-85 units. heparin per 1 kg of body weight partly exfuse 900-800 ml of autologous blood into plastic containers of the Gemakon 500 type, and after equilibrating the containers, the latter are centrifuged in a PC-6 centrifuge at 2700-2800 rpm and 22 ^o C for 10 min . Plasma is removed through crossed container junction lines using a plasma extractor. The red blood cells remaining in the containers are mixed with a solution containing polyvinylpyrrolidone (for example, with hemododesis) in a 1: 1 ratio, incubated at 36.9-37.1 ^o C for 15-20 minutes, centrifuged again at 2700-2800 rpm and 20-22 ^o C for 10-15 minutes, the supernatant is removed with a plasma extractor. The washed red blood cells are again diluted with saline in a ratio of 2: 1 and administered to the patient intravenously. The operations of the proposed method are carried out from one to three per one patient, alternating them every other day.

 The plasma-preserving mechanism of the method and the possibility of reducing the amount of blood sampling are based on a deeper blood purification when washing red blood cells with solutions containing polyvinylpyrrolidone (for example, hemodezom), whose macromolecules, forming paraerythrocyte binding centers, actively adsorb toxins and water on themselves. With the introduction of erythrocytes thus treated into the patient’s vascular bed, toxins not removed by plasmapheresis are sorbed on their membranes, providing an additional detoxifying effect. Due to this effect, the need to remove large volumes of plasma is reduced and it becomes possible to reduce the volume of its exfusion, and, consequently, plasma displacement.

Patient P., 46 years old, medical history N 5326. Diagnosis: gangrenous abscess of the lower lobe of the right lung. The patient was prescribed: Ampioks 1.0 g 6 times a day, strophanthin 0.025% 1.0 ml on glucose 5% drip iv once a day, calcium chloride 10% 10.0 ml 1 time per day c, aminophylline 2.4%, 10.0 ml iv in a jet once a day, vitamins B ₁ , B ₆ and B ₁₂ according to generally accepted schemes, terpincode one tablet 3 times a day. The condition has not improved.

 After 7 days, in addition to the ongoing treatment, 3 plasmapheresis operations with red blood cell washing by hemodesis were prescribed. In total, three liters of the patient’s blood were fractionally processed. The condition improved significantly: the amount of purulent sputum increased in volume, the size of the abscess cavity and the level of its contents in the lung began to decrease. On the fluorograms, a gradual decrease in the abscess cavity from 8 to 3 cm and the disappearance of the liquid level in it were observed, sputum acquired a mucous character, and a putrid odor disappeared. On tomograms performed after 18 days, there is no data for a cavity in the lung; the area of perifocal infiltration has significantly decreased in size. Laboratory, clinical and biochemical analyzes fully reflected the dynamics of the clinical and radiological picture. The patient was discharged with recovery under outpatient supervision by a surgeon and a pulmonologist. Thus, the application of this method allowed to eliminate a large cavity in the lung without surgical intervention.

 Patient A., 47 years old, medical history N 4763. Diagnosis: acute gangrenous abscess of the lower lobe of the left lung with a breakthrough into the pleural cavity and the development of left-sided pleural empyema.

Given the clinic of acute pleural empyema, severe purulent-resorptive fever, plasmapheresis was prescribed with washing of red blood cells by hemodezis. Three operations were performed according to the above method. The condition improved: appetite appeared, sleep normalized, cough became more productive, body temperature decreased to 37.2 ^o C. With daily pleural punctures, 80 ml of pus was removed with intrapleural administration of kanamycin.

 On the fluorogram, performed after 6 days, there was only a small level in the pleural cavity. The dome of the diaphragm and the root of the lung became clearly visible. With a puncture, fluid and air in the pleural cavity were no longer detected. The patient was discharged with improvement at the place of residence for further treatment in a satisfactory condition.

 Compared with the known solutions, the proposed method allows you to quickly normalize body temperature, reduce the number of complications and fatal outcomes, speed up the purification of purulent wounds and epithelization, reduce the time of scarring of abscesses, wounds and, therefore, increase the efficiency of traditional plasmapheresis. In this case, it is possible to reduce the volume of plasma and plasma replacement preparations by 2–2.5 times in severe patients, and in patients in satisfactory condition, completely refuse plasma replacement, which will lead to significant cost savings for infusion-transfusion environments, since hemodesis and saline are much cheaper than plasma and albumin.

Claims (1)

The method of discrete plasmapheresis by separation of autologous blood by centrifugation into red blood cells and plasma, separation, removal of plasma and return of red blood cells to the patient by intravenous drip, characterized in that the red blood cells are mixed with a solution containing polyvinylpyrrolidone (for example, with hemododesis) in a ratio of 1: 1, incubated at 36, 9-37.1 ^o C for 15-20 minutes, then centrifuged again at 2700-2800 rpm./min for 10-15 minutes, the supernatant is removed, and the washed red blood cells are diluted with saline in a ratio of 2: 1.