SU1607816A1 - Method of treating exotoxic shock - Google Patents

Abstract

The invention relates to resuscitation and can be used to treat exotoxic current. The goal is to prevent complications in the treatment of a patient's exchange replacement. The method is carried out by exchanging the patient's blood with a perfusion mixture of blood and a colloid-crystalloid perfusion solution in a 1: 1 ratio with a total volume of 4-4.5 liters, while the perfusion mixture is administered intraarterially within 4-5 minutes.

Description

The invention relates to medicine, in particular to resuscitation, and can be used to treat an exotoxic cheek.

The aim of the invention is the prevention of complications in the treatment of exchange substitution of the patient’s blood.

Example 1. Patient G., 59 years old, weight 70 kg, delivered to the intensive care unit of the experimental design bureau at 15 h 20 min in a severe unconscious state with a diagnosis: poisoning with an unknown house, exotoxic shock III. Anamnesis unknown. The patient has pronounced respiratory failure, acrocyantosis, deep breathing, acne, 38-40 respiratory movements per minute. A pronounced hemic hypoxia is determined clinically. HELL 70/40 mm Hg, pulse PO beats. per minute, arrhythmic. The pupils are moderately dilated, the reaction to light in the ala, the corneal reflex is not detected. There is no urine during catheterization of the urinary bladder, and there are no burn marks in the oral cavity. Catheterized subclavian vein, CVP negative. IV Polyglukin Stream 400 ml, CVP

increased to 100 mm of water. Art., blood pressure is not stabilized. The therapeutic complex includes hormones, cardiac glycosides, and insufflation with oxygen.

In the study of the patient's blood, free plasma hemoglobin (hemolysis) was 20100 µg / ml, pH 7.12, BE ... -19 mmol / l. Plasma is 7.1 mmol / l, Hv- 150 g / l, hematocrit 0.38 l / l. The stomach was urgently rewashed, alkalization of the blood started (sodium bicarbonate 4% -700 ml i.v. in a jet). The infusion volume during the first hour of treatment was 1.5 liters (colloidal and crystalline media). Stabilization of blood pressure is not successful, CVP is increased to 100-120 mm aq. Art. Stimulation of diuresis (lasix 200 mg i.v.), the effect is not obtained. BP progressively decreases. It was decided to perform an operation to replace blood (OZK) under conditions of assisted blood circulation with extracorporeal corporeal oxygenation. The patient is urgently taken to the operating room. The condition has deteriorated. Blood pressure decreased to 0. CVP increased to 150 mm aq. Art. Respiratory failure (apnea). Intubation IVL

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pure oxygen. Intravenous: calcium chloride 10% -10 ml, adrenaline 0.1% -0.5 ml. HELL increased to 50/0 mm Hg. Art. An ISL - 4 apparatus is connected to the femoral vessels on the right, heparinizing 3 mg / kg.

The first exfusion was carried out with 2 l of the patient's blood from the venous knee within 2 minutes; the same volume of perfusate would be injected intraarterially. This achieved 40% hemodilution. A 4% solution of sodium bicarbonate 200 ml was added to the oxygenator. Then for 3 minutes, assisted blood circulation was carried out with a volumetric perfusion rate of 30 ml / kg / min. Blood pressure stabilized at the level of 100-110 / 70 mm Hg, CVP 100-120 mm aq. Art. Against the background of VC, the patient's blood was expelled again from a venous knee in a volume of 2 liters for 2 minutes (thus, the volume was increased to 4 liters by double exhalation), adding single-group donor blood (2.5 l) to the oxygenator, sodium bicarbonate (4% -200 ml) Then VK continued for 3 minutes. HELL 120/80 mm Hg Pulse 100 beats. per minute, rhythmic, CVP

120 mm aq. Art. Received 20 ml of dark brown urine. VC stopped by slow intra-arterial injection of perfusate. The device is disabled. The patency of the femoral vessels restored. The patient's condition improved significantly, acrocyanosis disappeared, microcirculation improved. IVL continued. MOD 17 liters (O2 60%). After 6–7 h after the OZK under conditions of VC, the patient came to seb. HELL steady 110/70 mm RT. Art. Pulse 95 beats. per minute, CVP 60-80 mm aq. Art.

Some biochemical blood parameters:

TO OZK After OZK

Hemolysis, µg / l20100950

HB blood, mcg / l 150110

Hematocrit, l / l0,380,32 l / l

To plasma, mmol / l 7,1418

PH7,127,28

BE mmol / l19-6

Total protein, g / l7462

As can be seen from the clinical example, VC allowed us to stabilize blood pressure and, without prejudice to the blood circulation, to perform OZK in a terminal patient with tons of poisonous hemolytic house poisoning, exotoxic shock And degree, which made it possible to avoid complications and death.

Example 2. Patient C., 35 years old, weight 75 kg, was admitted to the intensive care unit in a serious condition with a diagnosis of acute poisoning with acetic essence chemical burn of the oral cavity, esophagus, and mucous stomach.

The patient drank 100 ml of acetic essence and was delivered after gastric lavage and intramuscular injections of anesthetics delivered to the hospital. On admission, the state is severe, consciousness confused, restless, BP 75/50 mm Hg, pulse 130-134 beats. in minutes CVP is 5 negative. Urgent infusion, hormonal therapy started.

After intravenous administration of crystalloid and colloidal media in a volume of 2 liters, the CVP increased to 180 mm of water. Art. Infusion volume is limited. Due to respiratory failure, the patient is intubated and transferred to a ventilator (MOU 17 l, O2 60%). BP does not stabilize, the patient has anuri. In the study of blood, the level of hemolysis was 15800 μg / ml, pH 7.18,

5 BE ...- 15 mmol / l. It was decided to conduct an OZK in the VC conditions. In the operating room, an ISL-4 apparatus, heparinization of 3 ml / kg, is connected to the femoral vessels on the right.

The first exfusion of 2.5 l of the patient's blood from the venous knee was performed within 2 minutes; the same volume of perfusate would be injected intraarterially. This achieved a 50% hemoduodenum. A 4% sodium bicarbonate solution (250 ml) was added to the oxygenator. Then, VC was performed for 2 minutes with a volumetric perfusion rate of 30 ml / kg / min. BP stabilized at 110/60 mm Hg. Art., the pulse was less, with 134 beats. per minute decreased to 100 beats. in minutes CVP decreased from 180 to 80 mm of water. Art. Against the background of vc blood exfusus is repeated.

0 patient in a volume of 2 liters for 2 minutes (thus, 4.5 liters of the patient's blood was removed twice), adding single-group donor blood (3 liters), sodium bicarbonate (4% -250 ml) to the oxygenator. Then In K continued for another 2 minutes.

5 BP stabilized at 120/80 mm Hg. Art. Pulse 100 beats. per minute, CVP 120 mm aq. Art. Received 200 ml of dark urine. VC stopped by slow intra-arterial injection of per0 Fusat. The device is disabled. The patency of the femoral vessels restored. The patient's condition improved significantly, cyanosis disappeared, microcirculation improved. IVL continued. MOD 17 liters (O2 30%). After 4 h, the patient came to himself, then

5 through the assisted breathing stage is extruded. HELL 110/70 mm RT. Art. pulse 100 beats. in minutes CVP 80 mm aq. Art.

Some biochemical blood parameters:

odo OZKPosle OZK

Hemolysis, µg / ml15800400

Nb blood, gl150120

Hematocrit, l / l0,420,39

To plasma, mmol / l 6 54.5

рН7,187,32

Be mmol / l-15-5

Total protein, g / l5661

As can be seen from the clinical example, auxiliary blood circulation allowed

5 1607816g

to stabilize blood pressure and without prejudice to blood flow, in order to prevent

the circulation to conduct OZK at terminal and complications, blood replacement is carried out with

the patient with t jelly poisoning by He-using the device of the auxiliary hemolytic house, exotoxic shchemokoprascheni, moreover, a total III degree perfusion, which allowed to avoid the development of hemorrhoids 40-

of fatalities and deaths. 50% with double fractional exfi ,,, zia of blood with a total volume of 4-4.5 liters with one formula of the invention by the temporary addition of a 2% solution

The method of treatment of exotoxic sodium shokabarcarbonate in the amount of 400 by replacing the patient's blood, I distinguish 500 ml.

Claims (1)

Claim A method of treating exotoxic shock by replacing a patient’s blood, characterized in that, in order to prevent complications, blood is replaced with an auxiliary circulatory apparatus, and total perfusion is carried out with an initial hemodilution of 40-50% with a double fractional blood exfusion with a total volume of 4-4 , 5 l with the simultaneous addition of a 2% solution of sodium bicarbonate in an amount of 400500 ml.