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A method of treating preeclampsia in pregnant women with autoimmune diseases
A method of treating preeclampsia in pregnant women with autoimmune diseases
IPC classes for russian patent A method of treating preeclampsia in pregnant women with autoimmune diseases (RU 2191048):
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(57) Abstract:

The invention relates to medicine, namely to obstetrics and gynecology. A method of treatment of preeclampsia in pregnant women on the background of autoimmune diseases, which is to assign traditional therapy and conducting plasmapheresis and ultraviolet irradiation of blood in front of them spend infusion of physiological NaCl solution in the amount of 300 to 400 ml with the addition of a solution sibazona 0.2 mg/kg and Dimedrol 0.2 mg/kg, the session is performed in 2 stages; the first stage collect 300-400 ml of blood, her centrifugation at 1600 rpm for 15 min and plasmodesmata carried out depending on the initial hematocrit, total protein content and platelets in the blood of the patient; when the total protein content of blood from 60 to 80 g/l, platelets from 150 to 250 G/l, hematocrit of 32 to 36% plasmodesmata spend a physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma when the total protein content of blood from 60 to 80 g/l and platelets from 150 to 250 G/l and hematocrit > 36% plasmodesmata spend colloidal Rasbora and physiological solution of sodium chloride in the ratio of 2: 1 in the total quantity of the active ingredient is/l and hematocrit from 32 to 36% plasmodesmata conduct single-group of fresh frozen plasma in number, equal to one volume of removed plasma, and a physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma when indicators total protein content of less than 60 g/l, platelets less than 150 G/l and hematocrit > 36% plasmodesmata conduct single-group of fresh frozen plasma in the amount equal to one volume of removed plasma, and the colloidal solution in a quantity equal to one volume of removed plasma at the second stage is irradiated with the formed elements of blood with ultraviolet light with their simultaneous reinfuse. The method allows to increase the effectiveness of treatment of gestosis in the background of autoimmune sobolani. 3 C.p. f-crystals, 2 tab.

The invention relates to medicine, specifically to obstetrics and gynecology, and relates to methods of treatment of preeclampsia in pregnant women with autoimmune diseases.

Known methods of treatment of preeclampsia by assigning drug therapy. [1, 2].

However, these methods are not sufficiently effective and have side effects due to the use of a large number of drugs.

The closest (prototype) is a method of treatment of preeclampsia in pregnant women by conducting quantum remote 2 to 5, PA 1-5 times. Ultraviolet irradiation was carried out according to the method Werli at the rate of 1.5-2 ml/kg of body weight. PA conducted a discrete manner on the centrifuge CPR - 01 with a speed of 3000 rpm for 1 min Per session was deleted from 300 to 600 ml of plasma [3].

However, this method involving the removal of large amounts of plasma (600-800 ml or more in a single session), can lead to severe volemic shifts and significant losses of protein, for compensation which will need a transfusion of donor plasma in sufficient volumes. Therefore increasing the risk of transfusion reactions. The proposed mode centrifugation traumatic to blood elements. In addition, irradiation of the exposed whole blood, in which the shaped elements have not changed their qualities due to the effect of deletirovanie, and their volume is very small to obtain a sufficient effect.

The problem solved by this invention is to increase the effectiveness of treatment, reduce side effects.

The problem is solved according to the method of treatment of preeclampsia in pregnant women with autoimmune diseases by assigning traditional therapy and session of plasmapheresis and ultrafiltrate blood spend infusion of physiological NaCl solution 300-400 ml with the addition of a solution sibazona 0.2 mg/kg and mortar Dimedrol 0.2 mg/kg, the session is performed in 2 stages; the first stage collect 300-400 ml of blood, her centrifugation at 1600 rpm for 15 min and plasmodesmata carried out depending on the initial hematocrit, total protein content and platelets in the blood of the patient: if the total protein content of blood from 60 to 80 g/l, platelets from 150 to 250 G/l, hematocrit of 32 to 36% plasmodesmata spend a physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma; when the total protein content of blood from 60 to 80 g/l and platelets from 150 to 250 G/l and hematocrit > 36% plasmodesmata spend colloidal solution: reopoliglyukin, or eagleman, or rheomacrodex and physiological solution of sodium chloride in the ratio of 2: 1 in a total amount equal to twice the volume of removed plasma when indicators total protein content of less than 60 g/l, platelets less than 150 G/l and hematocrit from 32 to 36% plasmodesmata conduct single-group of fresh frozen plasma in the amount equal to one volume of removed plasma, and physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma when indicators total protein content of less than 60 g/l, the center is authorized by the plasma in the quantity equal to one volume of removed plasma, and the colloidal solution: reopoliglyukin, or eagleman, or rheomacrodex in the amount equal to one volume of removed plasma at the second stage is irradiated with the formed elements of blood with ultraviolet light with their simultaneous reinfuse, while the first and second steps are conducted sequentially, one after the other. Just do 3 sessions every two days.

The authors have not found a range of new distinctive features in the analyzed patent and scientific and medical literature. Thus, this solution meets the criteria of the invention: "novelty", "inventive step", "industrially applicable".

The method is as follows. From the second day of treatment prescribed sessions of plasmapheresis and ultraviolet irradiation of blood. System for blood transfusion PC 21-01 cut into two parts, stepping back from her needle 30-40 cm, and between the received segments are installing a quartz cuvette for UBI. The cuvette is placed in the apparatus for UBI device include warm-up, the shutter remains closed. The system is filled with a saline solution under aseptic conditions the dotted line peripheral menuiserie 0.2 mg/kg

After completing the infusion start drawing blood in a large container Gamecon", which contains a preservative that prevents the clotting of blood. Previously on the highway, connecting the large and small packages "Gamecon", place a clamp to prevent the flow of blood in a small package. Under aseptic conditions the needle system Gamecon" dotted line in another peripheral vein and begin exposio blood. Speed exposee blood is 30-50 ml/min, and the volume of the inflowing blood 350-400 ml During a blood supply in package "Gamecon carry out its periodic rocking for better mixing of the blood with a preservative. In the process of exfuze blood perform monitoring of blood pressure (BP) and pulse rate of the patient. The volume harvested the blood was determined by weighing the container with the consideration of its initial mass, which is approximately 100, After exposee blood needle package "Gamecon" delete from Vienna and cut off. On the remaining segment tubes tied 2 knots to prevent leakage of blood.

Through the system, which was used to preinfuse start plasmodesmata, which are carried out by the individual infusion-transfusion program in C is S="ptx2">

When the total protein content of blood from 60 to 80 g/l, platelets from 150 to 250 G/l, hematocrit from 0.32 to 0.36 l/l plasmodesmata spend only a physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma.

When the total protein content of blood from 60 to 80 g/l, platelets from 150 to 250 G/l, hematocrit > 36% plasmodesmata spend colloidal solution: reopoliglyukin, or rheomacrodex, or eagleman and physiological solution of sodium chloride in the ratio of 2:1 in a total amount equal to twice the volume of removed plasma.

When the total protein content of less than 60 g/l, and platelet count less than 150 G/l and hematocrit from 0.32 to 0.36 l/l plasmodesmata conduct single-group of fresh frozen plasma in the amount equal to one volume of removed plasma, and a physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma.

When the content of total protein from 60 to 80 g/l and platelets from 150 to 250 G/l and hematocrit more of 0.36 l/l plasmodesmata conduct single-group fresh frozen plasma chloride in a quantity equal to one volume of removed plasma, and the colloidal solution: reopoliglyukin, or R the infusion averages 100-150 ml for 10 min and adjusted depending on the blood pressure of the patient. Simultaneously with plasmodesmata spend centrifugation previously obtained blood and preparation for reinfused her uniform elements. For this purpose, the container Gamecon" with harvested blood set in a vertical position in the centrifuge Cup and weighed. To balance use another Cup filled with water. Then both tanks mounted on the centrifuge rotor in opposite brackets. Centrifugation is carried out at 1600 rpm for 15 min, resulting in the blood is separated into plasma and mass, consisting of formed elements. The blood pack is removed from the centrifuge Cup and place it in plasmacaster. On the main road between the small and large packages "Gemikona" form, but do not tighten the knot. From the line between packages "Gemikona" remove clamp and lead plasmacaster mode plasmaexact. After all the plasma will move from a large package into a small, plasmacaster return to its original state on the highway linking packages "Gamecon", place the clamp and tighten the node and between the cut line with a sterile scissors. On both sections of the railroad tie on two nodes. On average removed 200-300 ml of plasma, which is jut 150-200 ml of physiological solution of sodium chloride, then begin the second stage of the session.

The package prepared blood components connected to the system through which were plasmodesmata, open the roller blind apparatus for UBI and begin the ultraviolet irradiation with simultaneous reinfuse. UV radiation is subjected to the entire volume reinfusing blood components. Duration UBI is 20 min by irradiation area 30 cm2. After reinfused needle from a vein is removed and the puncture site should impose a pressure bandage.

Repeated sessions are conducted over 2 days. The course shall 3 sessions.

Rationale modes session
Transfusion physiological solution of sodium chloride before a session can increase blood volume and prevent undesirable hemodynamic effects during blood sampling, given that one of the important pathogenic signs of preeclampsia is hypovolemia. Diphenhydramine and sibazon have respectively antihistamine and sedative effects, ensuring the elimination of emotional stress during the procedure, reducing the severity of autonomic responses associated with changes in the volume to which eacci.

The proposed mode centrifugation enables you to share blood on the formed elements and plasma and simultaneously the least traumatic to blood elements.

This mode involves removing a small amount of plasma 200-300 ml per session, which is sufficient for obtaining the necessary therapeutic effect that does not lead to pronounced volemic shifts and significant loss of protein. In turn, the mode plasmodesmata developed taking into account the levels of total protein, hematocrit and platelet count, allows most physiological pick up not only quantitative, but also qualitative composition means for plasmodesmata. In addition, irradiation are formed blood elements, which are separated from the plasma, and the ultraviolet light is selectively blood cells, and is more pronounced clinical effect.

Clinical example
Patient M 26 years. Did 4.10.2000 year at the maternity ward 4, Tomsk complaining of thirst, edema, common on the lower extremities and the anterior abdominal wall, decreased urine output. The second pregnancy. The first one ended operation cesarean section regarding eclampsia in realnoe pressure (BP) is 106.6, cardiac index (SI) 2,420 l/min/m2total peripheral vascular resistance (SVR) 2640 Dyne/cm-5/s-1. In the fundus found expressed angiopathy in hypertensive type. In General, the analysis of blood: thrombocytopenia (120109), hemoconcentration (hematocrit 0,37%); in the biochemical analysis of blood: hypoproteinemia (total protein 52 g/l); tests of coagulation testified hypercoagulation.

After the examination the patient was diagnosed:
Pregnancy 32 weeks. Combined preeclampsia moderate severity on the background of autoimmune thyroiditis. The threat of premature birth. HWGP. The scar on the uterus. The severity at Goecke - Savelieva 11 points.

Medication therapy in the following amounts: nazepam 10 mg 2 times a day, magnesium sulfate 25% 5,0 2 times a day, aspirin 60 mg a day. From the second day of hospital stay began holding sessions of therapeutic plasmapheresis in combination with ultraviolet blood irradiation with the aforementioned method. Centrifugation was carried out in the centrifuge "PC - 6", UBI using the apparatus "Isolde".

The first session. Before the first session in the General analysis of blood has decreased platelet count (120109and introduction session conducted infusion of physiological NaCl solution 400 ml with the addition of a solution sibazona 0.2 mg/kg and mortar Dimedrol 0.2 mg/kg Blood sampling 380 ml centrifugation at 1600 rpm for 15 min, removed 270 ml plasma, plasmodesmata was carried out single-group of fresh frozen plasma in the amount equal to one volume of removed plasma (270 ml), and the colloidal solution reopoliglyukin in the amount equal to one volume of removed plasma (270 ml), reinfuse shaped elements full, through the apparatus for ultraviolet blood irradiation for 20 min, the exposed area 30 cm2.

II session. Before the second session in the General analysis of blood was determined by normal platelets (180109) and increased hematocrit (0,37%); in the biochemical analysis of a blood normal amount of total protein (63 g/l). Before conducting the session conducted infusion of physiological NaCl solution 400 ml with the addition of a solution sibazona 0.2 mg/kg and mortar Dimedrol 0.2 mg/kg blood Sampling 390 ml centrifugation at 1600 rpm for 15 min, removed 280 ml plasma, plasmodesmata was conducted colloidal solution reopoliglyukin and physiological solution of sodium chloride in the ratio of 2:1 in a total amount equal to twice the volume of removed plasma (560 ml), reinfuse shaped elements full, through the apparatus for ultraviolet blood irradiation for 20 min, the exposed area 30 cm2.

9) and normal levels of hematocrit (0,34%); in the biochemical analysis of blood reduced the amount of total protein (59 g/l). Before conducting the session conducted infusion of physiological NaCl solution 400 ml with the addition of a solution sibazona 0.2 mg/kg and mortar Dimedrol 0.2 mg/kg blood Sampling 390 ml centrifugation at 1600 rpm for 15 min, removed 270 ml plasma, plasmodesmata was carried out single-group of fresh frozen plasma in the amount equal to one volume of removed plasma (270 ml), and a physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma (540 ml), reinfuse shaped elements full, through the apparatus for ultraviolet blood irradiation for 20 min, the exposed area 30 cm2.

Already from the fourth day of treatment the patient noted improvement in health, increased urine output, normalized blood pressure, and Central hemodynamics. At the end of therapeutic plasmapheresis and UBI swelling remained only on the feet, hematocrit characterized normovolemia, the number of platelets 190109the level of total protein 62 g/l, triglycerides marked shift towards gipokoagulyatsii and strengthening fibrinoliticheskoi activity.

>Re-admission to hospital for antenatal hospitalization with a diagnosis of:
Pregnancy 37 weeks. Combined preeclampsia moderate severity on the background of autoimmune thyroiditis. HWGP. The scar on the uterus. The severity at Goecke - Savelieva 8 points.

Operated routinely at 38 weeks. Diagnosis:
Pregnancy 38 weeks. Urgent operational delivery in the head previa. The OAS. Combined preeclampsia moderate severity on the background of autoimmune thyroiditis. Thinning of the uterine scar. HWGP.

Child 7-8 points on the Apgar scale. Discharged for 12 hours in a satisfactory condition.

In the process of conducting therapeutic sessions of plasmapheresis in combination with ultraviolet irradiation of blood in pregnant women with preeclampsia in the background of autoimmune diseases was carried out dynamic monitoring of changes of some indicators (clinical, instrumental and laboratory), characterizing the severity of preeclampsia.

Analyzed the following parameters:
- Edematous syndrome;
- ADCADD, GARDEN, SVR, C;
- The state of the fundus;
- Biochemical parameters of blood;
- Peripheral blood;
- Indicators of urine;
- Triglycerides;

1. Changes in the cardiovascular system was characterized by declining ADWITHand HELLDand decrease in mean arterial pressure, Central hemodynamics on akineticheskie type circulation. It should be noted that the dose of antihypertensive drugs during sessions of therapeutic plasmapheresis (PA) in combination with ultraviolet blood irradiation was decreased, and in some cases were able to opt out of the use of antihypertensive drugs. So it is possible to state that one of the effects of this technique is the elimination of hypovolemia. This contributes to the applied mode of the fence and centrifugation of blood adequately conducted plasmodesmata taking into account baseline total protein, hematocrit and platelet count. As a result of the above effect is observed improvement of microcirculation (including kidney, as evidenced by the increasing amount of urine), decreased hematocrit (up to 32-34%), reduced severity of angiopathy of the retina, in addition, improves the rheological properties of blood by decreasing the aggregation properties of blood cells, fibrinolysis, decrease in thrombin activity, reduce the number of RCMP, obsequi increases oxygen capacity of blood and the ability of hemoglobin to release oxygen to the tissues, that allows you to improve the fetoplacental unit and to eliminate or reduce the occurrence of chronic hypoxia.

3. Using a combination of therapeutic plasmapheresis in combination with UBI allows you to prolong the pregnancy to the optimum time, reduces the number of complications in childbirth and the postpartum period are associated with a worsening preeclampsia.

The proposed regime, namely the sequence, the number of blood sampling, the number of sessions, selection of fluid solutions, have enabled us to achieve new technical result.

Sources of information
1. Silber, A. P. Medicine critical States. Petrozavodsk, 1995. - 360 C.

2. Obstetric and gynecologic care /Ed. by C. I. Kulakov. - M.: Medicine, 1995. - 304 S.

3. Zelevansky E. B. Application of quantum haemotherapy and plasmapheresis in the treatment of gestosis. The dissertation on competition of a scientific degree of candidate of medical Sciences. Voronezh, 1992.

1. Treatment of preeclampsia in pregnant women on the background of autoimmune diseases, which is to assign traditional therapy and conducting plasmapheresis and ultraviolet irradiation of blood, characterized in that the re number 300-400 ml with the addition of a solution sibazona 0.2 mg/kg and Dimedrol 0.2 mg/kg, the session is performed in 2 stages; the first stage collect 300-400 ml of blood, her centrifugation at 1600 rpm./min for 15 min and plasmodesmata carried out depending on the initial hematocrit, total protein content and platelets in the blood of the patient; when the total protein content of blood from 60 to 80 g/l, platelets from 150 to 250 G/l, hematocrit of 32 to 36% plasmodesmata spend a physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma when the total protein content of blood from 60 to 80 g/l and platelets from 150 to 250 G/l and hematocrit > 36% plasmodesmata spend a colloidal solution and a saline solution of sodium chloride in the ratio of 2:1 in a total amount equal to twice the volume of removed plasma when indicators total protein content of less than 60 g/l, platelets less than 150 G/l and hematocrit from 32 to 36% plasmodesmata conduct single-group of fresh frozen plasma in the amount equal to one volume of removed plasma and physiological solution of sodium chloride in the amount equal to twice the volume of removed plasma when indicators total protein content of less than 60 g/l, platelets less than 150 G/l and hematocrit bardaleeva plasma and colloidal solution in a number equal to one volume of removed plasma at the second stage is irradiated with the formed elements of blood with ultraviolet light with their simultaneous reinfuse.

2. Treatment of preeclampsia in pregnant women with autoimmune diseases under item 1, characterized in that the colloidal solution using reopoliglyukin or eagleman, or rheomacrodex.

3. Treatment of preeclampsia in pregnant women with autoimmune diseases PP. 1 and 2, characterized in that the first and second stages of the session is carried out sequentially one after the other.

4. Treatment of preeclampsia in pregnant women with autoimmune diseases under item 1, characterized in that the training is conducted three sessions of plasmapheresis and ultraviolet irradiation of blood every 2 days.

 

 
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