RU2284834C1 - Method for detoxication of biological liquids - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the present innovation deals with efferent ways for treating endotoxicosis due to cryoplasmapheresis. For this purpose it is necessary to sample biological liquid in a patient and obtain plasma due to centrifuging. Then plasma should be placed into a cylindrical container to be slowly frozen followed by defrosting it at the bottom and in the center of the container. Defrosted part of plasma should be removed, the remained one should be heated up to +37°C and reinfused for a patient. The innovation enables to decrease the loss of plasmatic part of biological liquid that leads to decreased number of complications in case of operative interferences.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to efferent methods of treating endotoxemia.

Currently, there is a method of partial or complete removal of toxic biological fluids, for example, the removal of toxic plasma from blood, lymph or the removal of toxic pleural fluid from the pleural cavity [5, 1].

The known method has several significant disadvantages:

1. The entire plasma part of the toxic biological fluid collected in the container is removed, therefore, the problem of its adequate replenishment arises.

2. The use of plasma substitutes or canned plasma for plasma replacement purposes can lead to specific reactions and the risk of transmission of viral infection [3, 4].

The purpose of the proposed method is to reduce plasma losses, complications and improve the detoxification effect.

This goal is achieved in that the detoxification of biological fluids is carried out by partial intermittent cryoplasmapheresis.

The method is as follows. Biological fluid, such as lymph or pleural fluid, is taken from the patient. By centrifugation in bottles at 2000 rpm for 10 minutes, the cellular elements of biological fluids are separated from the plasma. Previously, 5000 units are introduced into the vial. heparin. Then the cellular elements are returned to the patient’s body, and the plasma part of the biological fluid is placed in a device with a capacity of 500 ml for partial intermittent cryoplasmapheresis (figure 1). The device consists of: a cylindrical body 1, a fitting 2, a plug 3, a central round rod 4, the diameter of which is 5 times greater than the thickness of the side wall of the cylindrical container body, a cover 5 made of metal, for example stainless steel. A cylindrical container with a plasma closed with a lid is placed in a refrigerator and slowly frozen, for example, for 6 hours at a temperature of from-1 ° C to-3 ° C. Then the cylindrical container is removed from the refrigeration chamber and installed on the bottom of the heating element, such as a hotplate. When heated for a certain time, selected experimentally, for example 10 minutes, the parts of the frozen plasma adjacent to the bottom of the cylindrical container, the central round rod and a little - at the walls of the container, thaw. These parts of the plasma contain the largest amount of toxic substances (figure 2). Subsequently, the plug 3 is removed from the fitting 2 and the thawed toxic plasma is sucked out of the container. In this way, the most toxic part of the plasma is removed, for example, 40% of the total plasma volume in a cylindrical container. Then plug 3 closes fitting 2 and the remaining plasma is heated to + 37 ° C. A system for transfusion of liquids is connected to the nozzle 2 and the plasma is reinfused into the human body.

The method is based on the physical theory of freezing in a specific container of a homogeneous aqueous solution, such as biological fluid. First, ice crystals of water are formed from this solution, salt and other impurities, for example low- and medium-molecular toxic substances, are in the liquid phase and are concentrated (as if flowing from water crystals) in the lower and central parts of the tank [2].

To confirm this pattern, we carried out a series of 20 experiments. In this series of experiments, creatinine at a dose of 800.0 μmol / L was added to lymph plasma, placed in a cylindrical container with a diameter of 10 cm and a height of 6 cm. The container was closed with a lid and placed in the refrigerator at t ° -1 ° C, slowly frozen for 6 hours. Then, the frozen plasma was cut into cubes of 2 cm ³ and placed in test tubes under a specific number corresponding to a specific location in the container. After plasma thawing, creatinine was determined in each tube. The results of a series of experiments are presented in figure 2.

From the indicators of figure 2. it can be seen that as a result of slow freezing of the plasma of lymph, the amount of creatinine in the plasma of lymph of the lower zones of the cylindrical container became 2 times greater than in the upper zones, and in the central zones - 1.5 times more than in the upper lateral and mid-lateral zones.

The proposed method carried out detoxification of blood plasma taken from 9 patients with purulent-necrotic lung diseases at the age of 39 to 52 years. In all patients, severe severity of endotoxemia was verified, with initial toxicity indicators in the blood plasma: medium mass molecules - 0.521 ± 0.02 optical density units, creatinine - 157.0 ± 6.1 μmol / L.

After cryoplasmapheresis, the toxicity indicators of the remaining part of the blood plasma were as follows: medium-weight molecules - 0.432 ± 0.02 units of optical density, creatinine - 132.0 ± 5.4 μmol / l.

From the above data it is seen that there was a significant (P <0.05) decrease in plasma toxicity. All treated patients recovered.

The proposed method detoxified the pleural contents in 11 patients with toxic pleurisy or with empyema of the pleural cavity in patients with purulent-necrotic lung diseases aged 31 to 79 years. A study of the toxicity of pleural contents before and after cryoplasmapheresis of pleural fluid showed a decrease in medium-weight molecules (from 0.562 ± 0.31 units opt.pl. to 0.214 ± 0.26 units opt.pl., P <0.001) and creatinine (from 82 , 2 ± 7.6 μmol / L to 48.2 ± 5.1 μmol / L, P <0.001), i.e. an average of 2 times. There were no complications from the application of the developed method. All treated patients recovered.

We give examples of specific implementation of the method:

Example 1

Patient N., 44 years old, was admitted to the clinic on February 18, 2000 with a diagnosis of Abscessing left-sided lower-lobe pneumonia complicated by pleural empyema. Endotoxicosis of moderate severity was diagnosed. In the complex treatment, including antibacterial therapy, bronchial sanitation, drainage of the cavity of the lung abscess according to Monaldi, cryoplasmapheresis of pleural fluid was included according to the above method. The initial indicators of the severity of endotoxemia in the blood were as follows: the number of leukocytes - 12.4 × 10 ⁹ / l; toxic granularity of neutrophils - (++); leukocyte intoxication index - 4.5; Paramecium time 9.9 min; creatinine content - 116 μmol / l; molecules of average weight (E _{280 nm} ) - 0.450 units. opt.pl. Initial toxicity indicators of pleural fluid: creatinine - 146 μmol / l, medium-weight molecules - 0.862 units. opt.pl. Three days after the patient’s admission, four pleural fluid cryoplasmapheresis operations were performed at 3-day intervals between operations. After each cryoplasmapheresis operation, pleural fluid toxicity (in terms of creatinine and medium-weight molecules) decreased on average by 2 times. After 16 days of complex treatment of the patient in the clinic, the following indicators of endotoxemia in the blood were diagnosed: the number of leukocytes - 10.5 × 10 ⁹ / l; toxic granularity of neutrophils - (+); leukocyte intoxication index - 2.5 paramecium time 13.9 min; creatinine content - 86.2 μmol / l; molecules of medium weight (E _{280 nm} ) - 0.350 units. opt.pl. Pleural fluid toxicity indicators: creatinine 0.91 µmol / L; molecules of average weight - 0.556 units. opt.pl. Thus, the performed operations of cryoplasmapheresis of pleural fluid made it possible to reduce endotoxemia by one of its gradual gradations without any complications. As a result of the comprehensive treatment, a complete recovery of the patient was noted.

Example 2

Patient A., 26 years old, was admitted to the hospital on 10.12.1999 with a diagnosis of Post-traumatic left-sided destructive lower lobe pneumonia complicated by left-sided pleurisy.

Puncture of the left pleural cavity with subsequent evacuation of the pleural contents and its cryoplasmapheresis was introduced into the complex antibacterial treatment according to the method described above. When determining the toxicity of blood, the following indicators were found corresponding to a mild degree of endotoxemia: the number of leukocytes - 9.4 × 10 ⁹ / l; leukocyte intoxication index - 0.75, paramecium time - 19.5 minutes; creatinine - 80.5 μmol / l; molecules of average weight - 0.350 units. opt.pl. The following indicators of toxicity of pleural fluid were determined: creatinine - 82.24 μmol / l; molecules of medium weight (E _{280 nm} ) - 0.562 units. opt.pl. After cryoplasmapheresis of the pleural contents and reinfusion of the detoxified part of it into the pleural cavity, the toxicity indicators of steel were: creatinine - 48.2 μmol / L, medium-sized molecules - 0.214 units. opt.pl. Cryopheresis of pleural contents was performed three times with an interval of 3 days. 2 weeks after treatment, the indices of endotoxemia in the blood and in the pleural contents decreased to normal values. As a result of the comprehensive treatment, there were no complications, a complete recovery of the patient was noted.

The proposed method allows you to:

- reduce the loss of the plasma part of the biological fluid;

- reduce the number of complications from the operation;

- conduct effective detoxification of body fluid.

Information sources

1. Kabanov A.N., Sitko L.A. Empyema of the pleura. Irkutsk, 1985, p. 37-40.

2. Kirillin V.A., Sheindlin A.E., Shpilrein E.E. Thermodynamics of solutions. Moscow, Energy, 1980, p. 188-185.

3. Lopatkin N.A., Lopukhin Yu.M. Efferent methods in medicine. Moscow, Medicine, 1989, p. 264-280.

4. Plasmapheresis and its clinical significance: Discussion // Therapeutic Archive, 1984, No. 6, pp. 10-18.

5. Ryzhko V.V., Gorodetsky V.M., Borisov B.A. Intensive plasmapheresis - possible difficulties and complications // Therapeutic Archive, 1987, No. 6, p. 70-74.

Claims (1)

A method of detoxifying the body, including cryoplasmapheresis, characterized in that the plasma is placed in a cylindrical container, slowly frozen, then thawed at the bottom and in the center of the cylindrical container, the thawed part of the plasma is removed, and the remaining plasma is heated to + 37 ° C and reinfused to the patient.

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