SU1697815A1 - Method of hepatico-renal insufficiency treatment - Google Patents

Abstract

This invention relates to medicine, namely to the intensive care of emergency conditions. The purpose of the invention is to enhance the effect while simplifying the method and reducing the complications. For this, patients with the effects of hepatic and renal insufficiency, depending on the condition, are prescribed orally or enterosgel administered through a probe in an amount of 30 ml (2 tablespoons) 3-4 times daily between meals for 1.5-2 hours before meals . The course of treatment lasts 4-7 days. Before use, enterosgel is diluted in a ratio of 1:10 (100 g of sorbent-polymethylsiloxane and 1 l of distilled water. Table 1.

Description

This invention relates to medicine, namely to the intensive care of emergency conditions.

The purpose of the invention is to enhance the effect while simplifying the method and reducing the complications.

The method is carried out as follows.

After stating the occurrence of renal failure using clinical and laboratory signs of intoxication, depending on the condition, the patient is prescribed orally or enterosgel administered through the probe in an amount of 30 ml (2 tablespoons) 3-4 times a day for 1.5-2 hours. before meals. The course of treatment lasts 4-7 days, depending on the severity of the patient's condition. Repeat treatment is possible. Before use enterosgel should be diluted in a ratio of 1:10 (100 g of sorbent-polymethylsiloxane and 1 l of distilled water and shake.

PRI me R 1. Patient N., 54, entered on the aggravation of calculous pyelonephritis. Based on the clinical examination, a laboratory diagnosis was made: urolithiasis, chronic pyelonephritis, chronic renal failure. When entering the level of blood urea - 13.5 mmol / l, creatinine - 0.152 mmol / l. For the purpose of preoperative preparation, from 07/07/1985, administration of enterosgel 30 ml 4 times a day in the intervals between meals was prescribed, which enabled July 14, 1985. normalize the content of blood and urea and creatinine and 16.07.1985 to perform the operation - removal of stones from the kidney. The ingestion of enterosgel, 30 ml, 4 times a day, 1.5-2 hours before meals, was continued in the postoperative period, which allowed limiting the volume and then canceling the infusion therapy. The postoperative period was uneventful, without any complications. The patient was drunk

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san home in a satisfactory condition,

Example2. Patient K., 37 years old, was admitted with a diagnosis of viral hepatitis on the 10th day of illness. On admission, weakness, lack of appetite, nausea, yellowness and itching of the skin were noted. The level of total bilirubin was 167.1 μmol / l, the activity of alanine-i and aspartate aminotransferase-5, bi, 1.05 μmol / h. l respectively, the content of urea and urea nitrogen is 6.8 and 3.6 mmol / l, respectively. In the following days, despite the infusion therapy (hemodez, albumin solution, sorbitol, Essentiale, antihistamines), the patient's condition continued to deteriorate, the total bilirubin content increased to 273.3 µmol / l and the absorption-secretive function of polygamide decreased dramatically. nal liver cells (according to radioisotope research). The hepatic insufficiency was joined by the occurrence of renal insufficiency in the urine of protein 0.99 g / l, leukocytes - up to 20 in the field of vision, little red blood cells to 10 and an increase in blood urea to 9.7 and urea nitrogen - to 4.5 mmol / l respectively. 8 due to the ineffectiveness of therapy for 5 days, enterosorption was carried out with enterosgel, 30 ml three times a day between meals and drugs. As a result, the patient's condition improved, the effects of intoxication were significantly reduced, skin itchiness, weakness, appetite. Laboratory data showed improved liver and kidney function with a decrease in bilirubin level to 255 µmol / l, urea and urea nitrogen to 5.1 and 2 , 5 mmol / l, respectively, the emaciation of the patient and the palpable dense liver were the basis to suspect the presence of a tumor in the pancreatoduodenal zone. Produced by laparotho (postoperative flow - smooth), after 2 weeks the patient was discharged in a satisfactory condition.

The advantages of the proposed method consist in its significantly greater efficiency compared with the prototype method. There is a significant reduction in clinical laboratory intoxication phenomena characteristic of renal and hepatic failure, which leads to the creation of a favorable background for performing surgical interventions (if necessary). lowering the frequency of postoperative

complications and mortality, shortening the treatment time ..

The table shows a comparative analysis of biochemical blood parameters characterizing the nitrogen-secreting kidney function during treatment by the proposed method and by the prototype method, where P is the significance of differences compared with baseline data.

As can be seen from the table, the level of metabolites does not change during hemosorption (method - prototype): urea, urea nitrogen, creatinine. As a result of the proposed method, this level decreases to 42.3-83% (depending on the type of metabolite). The differences are statistically significant. In the treatment of the proposed method, to a greater extent than in the treatment with the method of the prototype, the level of indicators of liver failure decreases, for example, a decrease in the bilirubin content in the blood occurs by 18% and 12.7%, respectively.

In the treatment with the proposed method, the nature of the protein-electrolyte composition of the blood is of a favorable nature, while in the treatment with the prototype method, there is a tendency to decrease in total protein, fibrinogen, potassium and prothrombin index.

The frequency of postoperative complications (bleeding, postoperative wound suppuration, development of gall perits: ig, fistulas, etc.) in patients who underwent hemosorption according to the prototype method reached 19.1%, and postoperative mortality - 14.9%. At the same time, the incidence of complications (partial suppuration of a postoperative wound in the place of abdominal drainage, bleeding) in patients who received an enterosorpent according to the proposed method was 9.2%, mortality rate was 9.3%. At the same time, the duration of inpatient treatment by the proposed method decreased by an average of 3-5 days.

In addition, the proposed method does not have the disadvantages of using hemosorption detoxification according to the method of the prototype, namely the hemolysis accompanying it, arterial hypotension, pyrogenic reactions, thrombosis of vascular shunts. Hemorrhagic syndrome and the risk of bleeding limit the indications for hemosorption and make it impossible to carry out a day or three after surgery, the proposed method does not regulate the implementation of surgical interventions and allows for the planned detoxification of the body both actively and passively (through a probe), depending from the condition of the patient. The absence of the risk of bleeding during enterosorption by the proposed method allows it to be carried out in the presence of a hemorrhagic syndrome, including to reduce the resorption of blood decomposing in the intestinal lumen.

A significant advantage of the proposed method is its simplification compared with the prototype method. Enterosorption according to the proposed method does not require heparinization of the patient, medical infusion support, special equipment and equipment, trained personnel. Thus, the cost of treatment is reduced by 7 times, which leads to a pronounced economic effect of treatment by the proposed method.

Thus, the ease of implementation, the practical absence of contraindications and complications of the proposed method allow it to be used for the purpose of detoxification in various fields of medicine.

FORUMAWLAH AND ISLANDS

A method of treating hepatic and renal insufficiency by sorption of toxic substances from an organism, characterized in that, in order to enhance the effect

while simplifying the method and reducing the complications, enterosgel 30 ml 3-4 times a day between meals is administered orally or through a probe.

Claims (1)

A method of treating hepatic-renal failure by sorption of toxic substances from the body, characterized in that, in order to enhance effect 15 while simplifying the method and reducing complications, enterosgel is administered orally or via a tube 30 ml 3-4 times a day in between meals . Indicator, mmol / l Prototype method (sorbents with UGS, KAU, SKN) The proposed method Before treatment After treatment Before treatment After treatment Urea P 10.7 ± 1.20 11.3 ± 2.00 34.9 ± 1.20 20.1 ± 0.60 <0.001 Urea N 6.5 ± 0.80 6.8 ± 0.70 18.2 ± 0.90 8.4 ± 0.10 <0.001 Creatinine P 0.139 ± 0.07 0.117 ± 0.04 0.323 ± 0.015 0.054 ± 0.007 <0.001