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обусловленных холедохолитиазом/ И.В.Иоффе, В.П.Потеряхин. -Украшський журнал екстремально! медицини iMem Г.О.Можаева. - 2009. -Том 10, №1. -= С.122-125.
UDK 616-083.98-08:615.382
Akentiev S. O., candidate of medical science
Associate professor of the department of Anesthesiology and Resuscitation
Berezova M.S., candidate of medical science Assistant of the department of Internal Medicine of Higher State Educational Institution of Ukraine «Bukovinian State Medical University»
Ukraine, Chernivtsi APPLICATION OF PLASMOSORPTION IN SYNDROME OF KIDNEY FAILURE UNDER THE CONDITIONS OF INTENSIVE THERAPY
Аннотация
Проведен анализ влияния плазмосорбции (ПС) в группе больных с синдромом почечной (острой и хронической) недостаточности (20 больных, 37 сеансов). Контрольная группа с 5 больных с подобными нозологиями, которым проведен плазмаферез. Детоксикационный и диуретический эффекты ПС, преимущества ее методики способствуют регрессу синдрома почечной недостаточности и восстановлению собственных детоксикационных механизмов организма.
Ключевые слова: эфферентная терапия, плазмосорбция, плазмаферез, элиминация метаболитов, мочевина, креатинин, мочевая кислота.
Abstract
The analysis of the influence of plasma sorption (PS) in a group of patients with a syndrome of the renal (acute and chronic) failure (20 patients, 37 sessions) was conducted. The control group included 5 patients with similar nosologies, who had undergone plasmapheresis. The detoxification and diuretic effects of PS, the advantages of its methods contribute to regression of the syndrome of kidney failure and restoration of its own detoxification mechanisms of the organism.
Key words: efferent therapy, plasma sorption, plasmapheresis, elimination of metabolites, urea, creatinine, uric acid.
The problem of intensive treatment of endotoxicosis in acute and chronic kidney diseases remains relevant today. It is already traditional, that the methods of extracorporeal detoxification: hemodialysis, hemosorption, and others are used for detoxification in this pathology. [1]. The authors have some experience in using the method of plasma sorption (PS) for this syndrome, caused by a number of nosological forms of kidney disease, with different etiology, pathogenesis, clinic, morphology and prognosis [2]. PS is an effective method of detoxification based on the sorption technology after the separation of blood into globular and cellular components.
Objective. To assess the effectiveness of the use of PS in the complex
therapy of kidney failure syndrome by determining its effect on the dynamics of nitrogenous residues.
Materials and methods. PS was performed as part of complex treatment for 20 patients (37 sessions). It was carried out on the first 1-2 days of the patient's admission to the intensive care unit (Chernivtsi, Regional Clinical Hospital, chief physician Ushakov V.I., Head of the Department of Anesthesiology with intensive care beds Rusnak A.D.). In the patients undergoing surgical intervention, PS was performed in the postoperative period. On average, one patient had 1-2 sessions. By gender: 10 men and 10 women. The structure of nosological forms included both acute cases and exacerbations of chronic diseases: chronic glomerulonephritis (4), chronic pyelonephritis (2), acute glomerulonephritis (2), sepsis (1), peritonitis of various genesis (5), pancreatic necrosis (1), calculous cholecystitis (2), dysentery (1), acute intestinal obstruction (1), obliterating atherosclerosis of the vessels of the lower extremities, condition after the surgery (1). By age: up to 30 years - 6; 31-40 years - 2; 41-50 years - 1; 51-60 years - 4; more than 60 years - 7 patients. PS was performed in a routine intermittent (fractional) way. The separation of blood into the globular and cellular components was done using the force of gravity. During the session, 800-1200 ml of plasma was obtained, purified and returned to the patient. The process of PS included the following steps: a) preparation of the system with hemosorbent ("CKH-4M", "CKH-2K"); b) preparation of the patient for detoxification (puncture of both subclavian veins); c) sampling of the first portion of blood into plastic containers "Hemacon - 500/300" or glass vials of 500 ml; d) centrifugation of blood (the centrifuge ^^6", operating mode - 2 thousand revolutions / minute, time of centrifugation 15 minutes); e) separation of plasma from the formed elements by means of the plasma extractor "PE-01"; f) the return of the formed elements and purified plasma to the patient; g) repeated cycles of sampling, purification and return of biological liquids to the patient; h) the end of the PS session. The comparison group included 5 patients with the similar nosologies mentioned above who underwent plasmapheresis (PF) for detoxification. During a session, up to 900 ml of toxic plasma was removed. Adequate plasma replacement was performed intravenously with 400 ml of a solution of 10% albumin, 450 ml of rheoporygluclnum, 200-250 ml of isotonic sodium chloride solution. Biochemical studies of urea, creatinine and uric acid were performed on the day of operation in blood, in plasma, separated from the formed elements, before and after sorption through the hemosorbent column, and also in the blood after the PS 3 days in a row. In addition, daily diuresis and the excretion of nitrogenous residues per 100 ml of urine were determined.
Results and discussion. It is known that one of the tasks of efferent therapy is a certain reduction in the excess of different metabolites or xenobiotics to a level in which there is no breakdown of adaptation processes, but on the contrary, there is a restoration of the activity of their own detoxifying systems. Blood urea in this group of patients was on average 24.4 ± 3.9 mmol / L, plasma urea after
separation from the formed cells to the column was 21.5 ± 1.5 mmol / L, and after the column with hemosorbent - 4, 3 ± 0.2 mmol / l (p <0.05). Consequently, the percentage of the sorbent urea binding was 80%. Below are the data on the dynamics of the blood urea, the excretion of urea per 100 ml of urine as well as diurnal diuresis (Table 1)
Table 1
The dynamics of the blood and urine urea (per 100 ml), as well as diurnal diuresis under the influence of PS (n=20, Mx±o)
Value Value dynamics
Before the The first day The second day The third day
operation
Blood urea, 24,4±3,9 21,3±3,2 23,9±4,3 21,7±4,3
Mmol / l
Urine urea, g / 1,0±0,08 1,2±0,08 0,97±0,13 1,4±0,17
100 ml
Daily diuresis, 925±166 1085±167 1367±232 1236±68
ml
The data show the tendency of a gradual decrease of the blood urea with a parallel increase in its concentration in 100 ml of urine after a PS session. The feature of efferent methods, in particular, a resumption and increase in daily diuresis. The sensitivity of the patient to the diuretics is restored. This effect is of particular importance, as it is accompanied by the phenomena of reducing intoxication, improving the patient's condition, and the positive dynamics of the concentration of metabolites. In the patients undergoing PF, the blood urea before the detoxication operation was 29.8 ± 6.9 mmol / l, on the first day after it - 29.5 ± 2.5 mmol / l, and on the second day - 20.1 ± 2 , 8 mmol / L, which did not always correlate with the patient's condition. A similar situation is with the dynamics of creatinine. For instance, its concentration in the blood on the day of the procedure was 567.0 ± 111.3 ^mol / l. In the plasma, after separating it from the formed elements, this figure was 445.0 ± 106.0 ^mol / l. The latter fact indicates that a part (in this case 22%) of creatinine remains with the formular elements and does not undergo sorption on the column. After the column, the concentration of creatinine in the plasma was 18.2 ± 2.6 ^mol / L (p <0.05). The percentage of creatinine sorbent binding was 96%. Below are the data on blood creatinine, daily diuresis and creatinine excretion per 100 ml of urine in the dynamics (Table 2)
Table 2
Dynamics of blood and urine creatinine (per 100 ml), as well as diurnal diuresis influenced by PS (n=20, Mx±o)
Value Value dynamics
Before the The first day The second day The third day
operation
Blood creatinine, 567,0±111,3 403,8±85,5 402,0±115,0 417,7±135,4
^mol / l
Urine creatinine, 0,13±0,03 0,18±0,03 0,13±0,03 0,11±0,02
g/100 ml
Daily diuresis, 925±166 1085±167 1367±232 1236±68
ml
Despite the high absorption capacity of hemosorbent to the blood creatinine, the latter did not undergo any abrupt changes, but it tended to decrease gradually. In the patients with PF the blood creatinine before the procedure was 483.4 ± 154.0 ^mol / l, and on the first day after the session it increased up to 700.0 ± 350.0 ^mol /l.
The level of uric acid in blood did not exceed the norm: 389.4 ± 45, kMol / l, and in plasma after the separation of formed elements its level was 358.3 ± 72.3 ^mol / l. After sorption, the uric acid concentration dropped to 55.9 ± 14.9 ^mol / l. The absorption capacity of hemosorbent in uric acid was 94%.
Thus, using PS in the group of patients with kidney failure is accompanied by positive detoxification and diuretic effects. When it is performed, it clears and returns its own plasma to the body. Formed blood elements avoid the negative effects of the column and return to the body intact along with the plasma. The thesis is confirmed that even a small "artificial" excretion of excess metabolites contributes to the subsequent unblocking of their own detoxifying mechanisms and the final sanogenesis.
References:
1. Лопаткин Н.А. Эфферентные методы в медицине/ Н.А.Лопаткин, Ю.М.Лопухин. - Москва: Медицина, 1989. - С. 27-257.
2. Коновчук В.М. Застосування плазмосорбци в порiвняльному аспект з гемосорбщею та плазмаферезом у кштщ штенсивно! терапи/ В.М.Коновчук, В.О.Калугш, Л.В.Станкевич, С.О.Акентьев, М.М.Кокалко. - Галицький медичний вюник. - 1999.-№2.-С.36-39.
