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МЕДИЦИНА И ЗДОРОВЬЕ
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 DYNAMICS OF PROTEIN LEVEL IN THE PROCEDURE OF THE DISCRETE VARIANT OF PLASMOSORPTION
Abstract. The article deals with the peculiarities of the discrete variant of plasma sorption at the initial stages of the procedure in 75 patients, divided into four groups: a) with liver failure syndrome; b) with renal failure syndrome; c) with liver-kidney failure syndrome; d) with other syndromes. The obtained results indicate the protein-retaining effect of plasma sorption, which makes it possible to apply it in case of concomitant hypoproteinemia.
Key words: plasma sorption, liver failure, renal failure, hypoproteinemia.
Резюме. Указаны особенности проведения дискретного варианта плазмосорбции на первых этапах процедуры у 75 больных, разделенных на четыре группы: а) с синдромом печеночной недостаточности; б) с синдромом почечной недостаточности; в) с синдромом печеночно-почечной недостаточности; г) с другими синдромами. Полученные результаты свидетельствуют о белоксохраняющем эффекте плазмосорбции, что дает возможность проводить последнюю при сопутствующей гипопротеинемии.
Ключевые слова: плазмосорбция, печеночная недостаточность, почечная недостаточность, гипопротеинемия.
The use of efferent therapy methods plays a significant supporting role (1), in particular in intensive care units, with the aim of detoxification in the treatment of a number of diseases with endotoxicosis. However, their use often becomes crucial in the absence of response to traditional therapy (2). It is known that even a slight "artificial" removal of excessive amount of toxins from the body contributes to the restoration of the activity of its own detoxifying systems and the final sanogenesis.
In the previous studies (3) a number of advantages of plasma sorption (PS) use in conditions of intensive care and resuscitation have been proven by the authors. Fractional (discrete) variant of PS have been applied in 75 patients in four groups of the diseased: a) liver failure (acute and chronic); b) renal failure (acute and chronic); c) liver-kidney failure; d) other syndromes that were not
accompanied by liver and kidney insufficiency, or they have not developed in the course of the disease. The discrete PS procedure itself included the following steps: a) preparation of a system with hemosorbent (brand of the sorbents used -"SKN-4M", "SKN-2K", "GDH" (Ukraine), b) preparation of the patient to the procedure (puncture of two subclavian veins); c) collection of the first portion of blood into the plastic containers of the type "Gemacon 500/300"; d) centrifugation of blood (centrifuge "PS-06", mode of operation - 2 thousand rev/min, time of centrifugation - 15 minutes); e) separation of plasma from blood corpuscles (plasma extractor "PE-01"); f) the return of the blood corpuscles and plasma purified by means of column with sorbent to the patient; g) repeated collection of subsequent portions of blood; h) termination of the PS procedure. Unfortunately, not all the hemosorbents (plasmosorbents) are selective. The current level requires the development of new sorbents, the selectivity of which would allow the removal of only programmed toxic substances from the blood.
In the group of patients with liver failure syndrome (27 people), at the stage of plasma separation from the blood corpuscles, a portion of the total protein (20%) remained with the cell pool. Thus, before the procedure the blood protein was 69.1±4.3 g/l. After separation of plasma into the last one, total protein already equaled to 55.2±6.3g/l. The obtained plasma was detoxified by passing it through a detoxifying system: a column with a corresponding plasmosorbent (hemosorbent). Sorbents, which were used in the work, were characterized by universality. Thus, the plasma protein concentration after sorption became even smaller - 39.5±4.6 g/l. Consequently, the absorption capacity of the sorbent in relation to the total protein was 28%.
In the group of patients with renal insufficiency (20 people), changes in protein levels were as follows. The initial total protein level was 61.7±2.7 g/l. At the stage of separation of plasma from the blood corpuscles it was 54.5±3.6 g/l. Consequently, 12% of the total protein remains in a plastic container with a cell pool. After sorption, the protein concentration is reduced by 22% and constitutes 42.3±2.6 g/l.
The third group of patients with hepatic insufficiency (26 people) was characterized by the same changes. The initial total protein value was 66.0±1.4 g/l. In the plasma, separated from the blood corpuscles, the protein level reached 56.0±1.6 g/l. 16% of the total protein remained in a plastic container with a cell pool. After the sorption of the isolated plasma, the protein index was still lowering - 39.7±2.2 g/l. Thus, the absorption capacity of the sorbent by protein was 29%.
The fourth group of patients (20 people) served as a peculiar group of comparison, since patients had no liver or renal insufficiency, or these diseases have not developed yet in the process of increasing endotoxicosis. The total protein before the detoxification operation was 65.8±2.4 g/l. After plasma separation, the index of protein in it was 54.4±1.9 g/l. 17% of the protein remained in a plastic container. After sorption, the plasma protein was 41.8±3.5 g/l. Consequently, the absorption capacity of the sorbent in relation to the protein
constituted 23%.
The above data suggest that the PS procedure itself with the use of sorbents has a negative impact on the dynamics of the total blood protein during the passage of plasma through the sorbents that do not have selectivity but have the nature of universality. Physicians who practice sorption methods of extracorporeal detoxification should be aware of the peculiarities of the discrete (fractional) variant of the PS.
Despite the data obtained, it should be noted that during the further study no significant changes in the total protein in the blood were detected during the first and next two days after the procedure of detoxification (Table 1).
Table 1
Group of patients Total protein dynamics
Before the operation 1 st day 2nd day 3rd day
1st 69.1±4.3 68.0±4.0 69.8±6.6 69.8±4.6
2nd 61.7±2.7 64.8±1.9 66.5±2.7 63.6±3.1
3rd 66.0±1.4 67.1±1.3 70.2±2.2 67.9±2.4
4th 65.8±2.4 68.2±2.4 65.5±1.5 61.6±2.6
According to the data, mentioned above, there were no significant changes in total blood protein dynamics in the PS process after the detoxification procedure. The authors explain this, firstly, by a partial decrease in the toxic load on the liver; secondly, by the stimulating effect of the procedure on the protein synthesis in the liver; thirdly, by purification of comparatively small doses of plasma: in different groups, the amount of plasma purified during one session ranged from 700-800 to 1200-1400 ml.
Consequently, we can draw the following conclusions. In severe forms of intoxication with a discrete variant of the PS, not the whole protein undergoes sorption. Some part of it remains with a cell pool under gravity surgery separation. This part in the mentioned groups ranges from 12 to 20%. During the earliest postoperative period, the PS does not reduce the total protein of the blood, which makes it possible to use this method carefully as a method of choice in patients with concomitant hypoproteinemia.
References:
1. Лисенюк В.П. Методи комплементарно!' медицини в сучаснш лшарськш практищ / В.П.Лисенюк, Г.Г.Симомненко, О.М.Головчанський, А.К.Кожанова, М.1.Наумова та ш. - Проблемы медицины, 1998. - №1. - С.4-7.
2. Деденко И.К., Стариков А.В., Литвинюк В.А. Эфферентные методы лечения острах отравлений / И.К.Деденко, А.В.Стариков, В.А.Литвинюк. -К.: Нора-принт, 1997. -С.237.
3. Коновчук В.М. Застосування плазмосорбцп в порiвняльному аспект з гемосорбщею та плазмаферезом / В.М.Коновчук, В.О.Калупн,
Л.В.Станкевич, С.О.Акешъев Акентьев С.О. та iH. - Галицький лiкарський вiсник, 1999. - №2. - С.36-39.
УДК 617-089
Аристова Е.Д. студент, 4 курс факультет Лечебное дело Ижевская Государственная Медицинская Академия
Научный руководитель: Стяжкина С.Н., доктор медицинских наук профессор
Россия, г. Ижевск АНАЛИЗ ЛЕТАЛЬНОСТИ СРЕДИ БОЛЬНЫХ ХИРУРГИЧЕСКОГО ПРОФИЛЯ ЗА 2017 ГОД В РАЙОНАХ УДМУРТСКОЙ РЕСПУБЛИКИ
Аннотация: Статья посвящена анализу летальных случаев среди пациентов хирургического профиля среди населения Удмуртской Республики за 2017 год. Проведен анализ клинических случаев для выявления наиболее распространенных причин летальных исходов. Проанализирована наиболее частая причина летальных исходов. В статье рассматриваются возможные послеоперационные осложнения, которые могли бы привести к повышению летальности среди больных хирургического профиля.
Ключевые слова: летальность; осложнения; хирургическая служба; неотложная хирургия; болезнь; мезентериальный тромбоз;
Aristova E.D. student
4th course, Medical faculty Izhevsk State Medical Academy Russia, Izhevsk Scientific adviser: Styazhkina S.N. doctor of medical Sciences, Professor
ANALYSIS OF MORTALITY AMONG SURGICAL PATIENTS FOR THE YEAR 2017 IN AREAS OF THE UDMURT REPUBLIC
Abstract: The article is devoted to the analysis of fatal cases among surgical patients among the population of the Udmurt Republic in 2017. The analysis of clinical cases to identify the most common causes of fatal outcomes. The most frequent cause of death was analyzed. The article deals with possible postoperative complications that could lead to higher mortality among surgical patients.
Key words: mortality; complications; surgical service; emergency surgery; illness; mesenteric thrombosis;
Известно, что анализ летальности позволяет сделать выводы об
