Method for body detoxification in critical endotoxicoses

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery and intensive therapy, and can be used in treating endotoxicoses caused by septic conditions. That is ensured by removal of a destruction area to be thereafter sanitised and drained. It is followed with lymphostimulating therapy by introduction of 0.25% Novocaine 60 ml with dissolved 0.1 g of Lydase and 1.0 ml of Pentoxifylline into the interspinous spaces in number of 1-3 injections. Further, discrete plasmapheresis in amount 400 ml for severe patients and 800 ml in moderate patients is applied in number of 1-8 procedures. The lymphostimulating therapy is alternated every second day with lymphotropic extracorporal pharmacoimmunotherapy with using a medicated mixture prepared by incubation of 40-60 ml of the patient's plasma with received plasma of the patient with Roncoleukin in dosage 500-1 million UN and Cefabol in dosage 1 g for 45 min at 37°C. In peritonitis and peritoneal sepsis, the medicated mixture is introduced in the bolus form in the retroperitoneal fat. The destructive processes in the pleural cavity require introduction of said mixture in the axillary cavity.

EFFECT: method provides endotoxin weakening in the bloodstream, intertissue spaces and cavities due to combined multidirectional local and system effect on the lymphoid system.

3 cl, 8 tbl, 3 ex

 

The invention relates to medicine and can be used for detoxification of the body in critical endotoxemia due to septic pathological conditions.

The problem of detoxification patients with peritonitis and peritoneal sepsis important and complex. The problem is dictated by the high mortality in severe endotoxemia, a large number of purulent-destructive complications, both from the side of the body and the abdominal cavity. The complexity measures to detoxify the body of the patient due to his critical condition. It is known that 90% of the mortality in emergency surgery due to endotoxicosis. However, only high-performance and total detoxification of the body is able to increase his chances of recovery, to reduce the quantity of hazardous secondary septic complications and mortality.

Known for a variety of detoxification methods in surgical patients, however, it is difficult to distinguish among them most effectively solves the problem. The reason is that endotoxemia is a multicomponent pathophysiological condition and multifaceted, interrelated and interdependent process. The structure of endotoxemia diverse and due to simple chemical products products is eljnosti body with toxic properties, and products of protein and bacterial accumulated in all environments of the body of the patient. Therefore, detoxification methods should be appropriate and focused on each range of these specific factors of endotoxemia, thus, measures to detoxify the body of the patient should be comprehensive in nature and should be differentiated according to the structure of the components of endotoxemia, and consider the impact on each component of endotoxemia, be specific by way of detoxification, aimed at "their" area and a compound of intoxication.

There is a method of detoxification methods, it is non-selective method of extracorporal hemocorrection, has the disadvantage of significant trauma shaped elements and often substantial unbalance of the blood coagulation system, in the form of gross violations of hemostasis and fibrinolysis, sharp aggravation of the patient during the procedure, the need for Central venous catheterization [1] (ñ.38).

There is a method of detoxification - hemodialysis - has a low removal efficiency weight substances molecular weight of not more than 1500 D.

The known method the HDF allows you to remove substances of molecular weight up to 5000 L, which is also insufficient to achieve a complete and radical red eye reduction is of endotoxemia [1] (p.32).

Isolated ultrafiltration and hemofiltration for effective removal of medium molecular substances during endotoxemia are carried out in a volume of 50-60% of the total body water (CET), in addition, the prevalence of this operation is hindered by the high cost of hemofilters and alternative solutions, which require a large (10-60 l). In these procedures there is a significant loss filter amino acid (7.5 g) and protein [1], which can affect the patient's condition [1] (p.36).

Limfosorbtsiya - requires special training of staff, as well as the need arises open thoracic duct catheterization, with implementation occurring loss of lymphocytes and platelets on the sorbent, which negatively affects the condition of the patient, especially those with low platelets. Notes often unpredictable nature of limouzine, the possibility of developing lymph fistula and disorders lymphatic circulation after removal of the drains.

A known method of detoxification is the method of extracorporal immunopharmacotherapy incubated autologous immunocompetent cells with cytokines, such as IL-2 (Roncoleukin biotech dose of 0.25-0.5 million IU), which, according to the authors, after two or three sessions allows you to attain a stable normalization pokazatel the th immunity in combination with a reduction of febrile reactions, improve trophic homeostasis [2, s-266]. However, the authors injected the medicine mixture intravenously, which greatly limits therapeutic effect on inflammation and does not have a direct impact on immune lymphatic structures, which significantly reduced clinical effect of this method. Therefore, this known method requires the creation of more favorable conditions for their implementation. Now consider that the immune system is part of a unified system of detoxification, providing initial recognition and fixation of alien genetic material. The basis immunomoduliruushimi therapy many authors see in the effective relief of the symptoms of endotoxemia and endotoxemia, but destructive processes occurring in the lymph nodes in severe surgical infections, lead to the destruction of areas of lymphopoiesis and the ineffectiveness of the drugs used [2, s-260].

Closest to the proposed method of detoxification is discrete plasmapheresis [1], is a method of extracorporal hemocorrection, based on the replacement of the plasma of the patient's blood components, blood products and blood substitutes, which are as follows: depending on the amount of plasmacyte this method can be called: plasma is the apheresis - when removing up to 70% of the volume of circulating plasma - CGO (low volume - up to 20% CGO, volumetric average - 20-50% CGO, high volume - 50-70% CGO); plasmopara - if exposures 70-150% CGO; massive plasmopara - when exchanging more than 150%

CGO.

The greatest effect of the operation may occur if you remove endogenous toxic substances (ETS) have a small coefficient distribution in the body and their localization is limited mainly by the volume of circulating blood. However, endogenous toxic substances in pathological processes, for example, peritoneal sepsis, accumulate in the gastrointestinal tract, abdominal cavity, and then get into the lymphatic and circulatory system, causing obstruction of the first and septicaemia last. In conditions of disturbed microcirculation, drainage and detoxifying functions of the lymphatic system, toxic substances beyond the vascular wall into the interstitium, which also requires detoxification effect on him.

The most serious drawback of plasmapheresis is the fact that together with the plasma removed from the patient's body and it contains proteins, enzymes, hormones and other biologically active substances needed by the body for normal functioning.

The known method also does not meet the goal of reaching the mouth of schiwago and full clinical effect of detoxification of the patient, is not universal, as it does not provide detoxification of the whole body, and only provides detoxification circulating blood. In addition, this method becomes effective at removing 70% of BCC, but not less than 20%, and it is not possible to radically reduce endotoxemia due to low efficiency. In addition, this method does not provide detoxification circulating lymph, interstitial fluid, and removing toxic products from the gastrointestinal tract and anatomical cavities of the body.

It is impossible to use discrete plasmapheresis as an independent way of detoxification because of the critical state is always accompanied by disseminated intravascular coagulation, hypovolemic syndrome, as it will lead to even more significant, is incompatible with the life of disorders of hemostasis and homeostasis. High-volume plasmapheresis leads to depletion of the pool of whey protein, coagulation factors, including F VIII, reducing the concentration of electrolytes, immunoglobulins and nonspecific factors of anti-infective resistance, With3component of complement, up to 30% of platelets [1] (p.44).

New technical problem - increasing efficiency through sustainable and clinically significant reduction in endotoxicosis and reduce complications.

To solve the problem in the way of detoxifying the body with critical endotoxemia, by conducting discrete plasmapheresis, additionally carry out the removal, sanitation and drainage of the lesion destruction, lymphotropic infostealers therapy, by introducing megastate space 60 ml of 0.25% solution of Novocaine with dissolved 0.1 g lidazoy and 1.0 ml of pentoxifylline 1-3 injections, extracorporeal farmacoterapia, then spend discrete plasmapheresis in a volume of 400 ml for the patients and 800 ml in patients with moderate, 1-8 procedures for conducting paracommandos therapy prepare medicinal mixture by incubation 40-60 ml of plasma of the patient with Ronkoleykin dose of 500-1 million ED, seablom dose of 1 g for 45 min at 37°C, and then injected the medicine mixture with peritonitis and peritoneal sepsis - bolus in the retroperitoneal tissue, 1-6 injection, and in inflammatory and destructive processes in the pleural cavity, 4-8 injection in the axillary fossa.

The method is as follows. On admission the patient assess his objective status, and indicators: FRI, APACHE II, blood biochemical parameters, the extent and characteristics of endogenous intoxication, the main source(s) of intoxication, and outline the main methods targeted therapeutic de is oxical of the patient's body.

In the presence of process inflammatory destruction in the abdominal (or chest cavity, in extremities) perform operations aimed at the destruction of the nidus, the restoration of the natural anatomic correlations, sanitation interested cavity, then installing permanent sanitation and drainage of the cavity and of the nidus.

The localization of the lesion inflammatory destruction in the abdominal cavity, the main emphasis is on permanent reorganization and detoxification of the abdominal cavity by creating a managed decompressive laparostomy, system installation prolonged flow-suction drainage and peritoneally. In parallel in a permanent mode used enterosorption by introducing into the gastrointestinal tract sorbents type intersorb, ecoflor.

To rescue the abdominal cavity in the presence of her hearth destruction implement multilevel numbering its drainage into podrebarac, in a small bowl and set flow-suction system in the abdominal cavity and in the center of destruction directly, according to the indications applied locally proteolytic enzymes.

With the increased intracolonic and intra-abdominal pressure, the threat of development of a syndrome of high intra-abdominal pressure and compression-ishemic the ski bowel syndrome impose decompressive laparostomy, with prosthetics peritoneum and the defect of the anterior abdominal wall, allowing permanent mode to change surface dressings and materials, absorbent pathological separated from the abdominal cavity and purulent-destructive hearth.

Monitoring the effectiveness of the sanitation of the abdominal cavity is performed by counting the bacterial numbers in 1 ml of wash liquid and the number of CFU/ml in permanent mode, daily.

Spend retroperitoneal lymphotropic therapy in the wounds of the anterior abdominal wall by introducing into the retroperitoneal tissue 60 ml of 0.25% solution of Novocaine with dissolved 0.1 g lidz and 1.0 ml of pentoxifylline.

After this is carried out restoration and stimulation of lymphoablative and lymphatic drainage of the retroperitoneal space, then exposium plasma in a total volume of 400 ml for heavier patients or 800 ml for patients with moderate, 1-3 procedure, conduct its incubation, then carry out the preparation of a medicinal mixture by incubation 40-60 ml of plasma of the patient for 45 min Ronkoleykin dose of 500-1 million UNITS, seablom at a dose of 1 g and injected the medicine mixture with peritonitis and peritoneal sepsis bolus in the retroperitoneal tissue, 1-6 injection, and in inflammatory and destructive processes in the pleural cavity - 4-8 injection in the axillary fossa.

Sparing di the specific plasmapheresis is performed in case of the indicators of the CEC, more than 90 UNITS, the amount of exfuze plasma is carried out in the range of 400-800 ml, 1-3 session, taking into account the condition of the patient, the sessions continued until normalization of the CEC and termination of bacteremia.

When markers of hepatic failure: elevated ALT, AST, degradation products of fibrin conducted additionally peripheral hemosorption.

The purpose of detoxification circulating lymph and venous blood, flowing from the bowels, exercise bolus infusion of solutions containing (according to indications) antibacterial drugs, antispasmodics, solutions, improves the rheological properties of the lymph, and other compatible on the pharmacodynamics and potentiating each other preparations in the retroperitoneal space, alternating between them (the next day) with bolus injections of novocaine solution (0,25% - 60,0 ml), dissolved in it lidz 0.1 g of pentoxifylline 1.0 ml for recovery and stimulation of lymphatic drainage in the lymphatic system and retroperitoneal space.

In order to remove the pathological products of metabolism, pathogenic microorganisms and their toxins, toxic content of the gastrointestinal tract in the stomach, small intestine, rectum installed probes that after rehabilitation hollow bodies used for irrigation mucous solutions enriched with oxygen to protect the mucosa from ischemia, eliminating the dehydration is hypovolemia, and subsequent to early enteral nutrition. In the presence of a previously installed or installed during operation refluxing gastrostomy or anotomy use them to install gastric or analnogo probes (or use sensing in periodic mode).

Monitoring the effectiveness of rehabilitation of circulating blood is performed by determining the number of molecules of average weight (MSM) and the content of circulating immune complexes (CIC).

Monitoring the effectiveness of exercise metabolism at the level of nitrogen in the urine, protein in blood plasma.

Control over the dynamics of the septic condition of the patient is performed in the rate of catabolism, indicators LEAH, KHS, the content of erythrocytes, platelets, leukocytes and their young form, and the albumin-globulin ratio (AGK).

Stimulation of intestinal peristalsis, normalization of microcirculation, analgesia carried out by setting long-term epidural block (BPA) level Th8-Th9, and the introduction of continuously 0.2% solution of Naropin speeds of 4-8 ml/hour, based on hemodynamic parameters.

Drainage and detoxification interested cavities provide compliance with the proposed principles:

1) technology total drainage of the abdominal cavity: over-, subhepatic, intrahepatic dreni the Finance, drainage extrahepatic ways, multi-level drainage of the abdominal cavity with respect to the fixed numbering of drainage, drainage of pelvis;

2) the principle of complete separation and prolonged drainage of pathological lesions and cavities to stop access of toxic substances in the anatomical cavity and the body;

3) the principle of flow-suction drainage for permanent removal of pathological products and microflora of purulent-destructive fire;

4) the principle of antiseptic and antibacterial effects on infectious lesion by irrigation with appropriate solutions;

5) the principle of enzyme and antifermentny influence the pathological process in order to reduce and mitigate the toxic effects accumulated in the blood and tissues and into the blood and tissue enzymes, for example, in acute pancreatitis, pancreatic necrosis (enzymes, enzymes);

6) the use of peritoneal dialysis as a means of additional (auxiliary) detoxification.

Monitoring the effectiveness of the drainage cavities, rehabilitation and detoxification of the contents of the cavities is performed by counting the bacterial numbers in 1 ml, the number of CFU/ml in the exudate and wash liquid, the amount of exudate and washing liquid in the dynamic mode.

Method d is toxicitiy spend on treatment of the underlying disease and comorbidities to defined outcomes and full normalization of homeostasis and regression of the pathological process.

On the background of the proposed method of detoxification of the body from the first hours of its implementation begins to show a gradual and then a significant positive trend, reflected in the subjective wellbeing of the patient, increasing physical activity, the clarification of consciousness, reduction of pain, in steady positive dynamics of indicators of endotoxemia, earlier restoration of function of the gastrointestinal tract (in the case of surgical interventions on the organs of abdominal cavity and peritoneal sepsis) and regression of the pathological process. In addition, there is a reduction of extravascular fluid, improvement of microcirculation, peripheral tissue perfusion, decreased oxygen demand, improving indices of Central hemodynamics, reduced hyperlactataemia, normalization of parameters of creatinine, urea, potassium and coagulation potential.

The positive effect is due to the layered direction of the impacts of the proposed method, including the detoxification process all interested media and systems of the body. Significant and steady reduction of toxic load on the body contributes to the activation of nonspecific own protective forces of the organism's reactivity stop hypercatabolism and create the Oia favorable conditions for the function of vital organs and systems of an organism of the patient.

In the proposed method uses the combined effect of discrete plasmapheresis and of extracorporal immunopharmacotherapy. To radically improve the clinical efficacy of extracorporal immunopharmacotherapy it should be implemented on the background of local detoxification lymphatic structures and direct impact on the lymphoid tissue of the medicinal mixture, to prevent the destruction of lymphoid tissue, to restore lymphoablative, lymph flow and immune function. The conduct of extracorporal immunopharmacotherapy for such a beneficial physiological background allows you to get the best clinical effect.

Only the optimal combination of several methods of detoxification, with a synergistic effect in the simultaneous mode of application or their permanent serial implementation, allows you to quickly, steadily and is very effective to reduce the concentration of endotoxin in the bloodstream, interstitial spaces and cavities. This approach allows you to quickly eliminate the negative influence of endotoxemia on the functioning of the vital organs, systems and the whole organism.

The reduction of endotoxemia is carried out on the basis of indicators: leukocyte index of intoxication, index, forecasting and evaluating the quality is of the treatment of patients with injuries, septic shock and peritonitis (acute discrimination and chronic health evaluation (APACHE II), biochemical parameters of blood: bilirubin, creatinine, urea, potassium, liver transaminases (ALT, ACT), prothrombin index, cumulative index thromboelastography (IIT) J=[R (min) × K (min)]: mA(mm), where R is the clotting time of blood, the formation of the clot, mA - density clot.

The aim of the proposed method of detoxification is a radical detoxification of the body and restore normal homeostasis by modifying the area of use of the medicinal composition, advanced recovery and stimulation of lymphoablative and lymphatic drainage, and an individual mode of their implementation based on the severity of the patient's condition and severity of endotoxemia.

Example 1. Patient P., 25 years old, was admitted to the urology Department of the city hospital №2, 13.06.06, with a diagnosis of acute destructive pyelonephritis right. Sepsis.

Upon receipt at the time of the examination: the patient's condition is severe, due to the syndrome of systemic inflammatory response developed against the background of the main purulent-destructive disease that was confirmed by the presence of foci of purulent infection during the operation - decapsulate the right kidney and drainage perinephral space, pyrexia up to 38.5°C, leukocytosis 14,1×109/l with p is Accademy shift to the left, up 9%, LEAH up to 6.0 units Given the severe septic condition of the patient, it is customary to carry out the detoxification according to the proposed method: the course sparing discrete plasmapheresis three treatments (13, 14, 16) in a volume of 800 ml, with in vitro farmacoterapia of EPIC (using 40 ml of plasma of the patient), in megastate intervals (retroperitoneal lymphotropic therapy) at the level of Th9-Th10, just 3 treatments. The number of procedures is justified by the objective condition of the patient, hemostasis and homeostasis.

Table 1. The temperature of the body of the patient P., 25 l, in the dynamics.

From table 1 it is seen that morning body temperature, the patient returned to normal on the second day, and evening - on the third, which indicates the high clinical efficacy of the proposed new method of treatment and comprehensive detoxification the patient P.

Table 2. The dimensions of the kidneys with ultrasound patient P., 25 l, in the dynamics.

Table 3. LEAH patient P., 25 l, in the dynamics.

Table 4. Urinalysis patient P., 25 l, in the dynamics.

As is seen in Appendix tables 1-4, on the second day after the start of treatment, worsening of the inflammatory process, characterized by increased leukocytosis up to 15.1×109/l; with a progressive band shift to the left, up to 15%, increase LEAH to 9.5 units, indicating expressed the military stimulation therapy and nonspecific defenses of the patient in response to a septic process. Marked clinical efficacy of the proposed method of treatment was further confirmed by positive dynamics of clinical and laboratory indicators: final normalization of body temperature on the fourth day; reduced leukocytosis and stab shift, normalized LII on the seventh day to 2.2 units; in the analysis of urine on the sixth day marked the termination of proteinuria, the presence of single cells in field of view; according to the ultrasound examination of the kidneys on the seventh day marked decrease swelling of the parenchyma of the right kidney. The patient was discharged with recovery at 14 days, under the supervision of a urologist at the clinic.

Example 2. Patient C., 42, enrolled 21.09.05, in the surgical Department of the hospital for emergency surgery with complaints of nausea, repeated vomiting. Diagnosis: common Acute fibrinous-purulent peritonitis in the toxic phase, two-day-old, due to acute pancreatic necrosis after prolonged alcohol load. Peritoneal sepsis.

After a two-hour pre-treatment with intravenous therapy in the volume of 2 liters, within 2 hours, the patient delivered on the operation.

Operation: verkhnesadinsky laparotomy, primary sanation of abdominal cavity, blocking the pancreas 0.25% solution of novocaine antitermite (octreotide 100 µg), a longitudinal cut in sterelny peritoneum and the capsule of the pancreas with a view to its decompression and create the optimum conditions for the outflow of pathological discharge, peritonial body of the pancreas with well-vascularized area of the greater omentum in the area of its body and tail, drainage above and podzolistogo space counter thermolabile the drainage of large diameter through the side podreberie space with parallel sensing thin (nipple) drainage for medicated irrigation cancer, diprionidae areas of necrosis of the tissue in the rear of the abdominal wall and their drainage opposing drainage of large diameter through lateral iliac areas, installation of flow-suction drainage, final aseptic drug sanation of abdominal cavity. Surgery was performed under conditions of combined anesthesia: endotracheal anesthesia (ATN) + long-term epidural block (DEB, install epidural catheter Th8-Th9).

Postoperative diagnosis: common Acute fibrinous-purulent peritonitis in the toxic phase, two-day-old, due to acute pancreatic necrosis after prolonged alcohol load, complicated the retroperitoneal phlegmon with extensive areas of necrosis retroperitoneal tissue. Sepsis.

The treatment according to the proposed method: antibacterial therapy, lymphotropic therapy through bolus through the day, Creston the x injection drug mixture (incubation 60 ml of plasma of the patient with Ronkoleykin dose of 500-1 million UNITS, seablom dose of 1 g for 45 min and 37°C) in the retroperitoneal tissue alternated with recovery procedures and stimulation lymphoablative and lymphatic drainage of the retroperitoneal space by bolus percutaneous injection of 60 ml of 0.25% solution of Novocaine with dissolved 0.1 g lidazoy and 1.0 ml, pentoxifylline) daily, infusion therapy, parenteral nutrition, 5-fluorouracil, sandostatin, with the first day of sparing discrete plasmapheresis in a volume of 400 ml, 3 sessions combined with in vitro farmacoterapia (AFIT) (using 60 ml of plasma of the patient). For stimulation of reparative processes, defenses were prescribed anabolic, immune-boosting drugs: retabolil, T-activin, vitamins, hormones. In addition, conducted oral enterosorption therapy to neutralize the pathological content and prevent translocation of microflora in the digestive tract.

Table 5. The mode of plasmapheresis and EPIC patient Century, 42,, in dynamics

Table 6. LEAH patient Century, 42, in the dynamics.

The postoperative course was hard. Hyperthermia up to 38.5-39°C was maintained for 2 weeks, intermittent pain for up to 4 weeks. Antibiotic therapy was performed taking into account the sensitivity of microflora. The total duration of treatment was 7 weeks. The patient was discharged from hospital in satisfactory SOS is the right under the supervision of a doctor.

Example. 3. Patient Z., 51, entered in GB No. 2 18.10.06 was diagnosed with cancer of the left breast, T4N1M0, the state after the combined treatment of 2000, late postradiation trophic ulcer of the lateral surface of the chest to the left. After preoperative examination and preparation 16.11.06, the operation-excision of the ulcer with grafting of the defect local tissues. The procedure takes 2 hours and 25 minutes. After the operation was transferred to the Department of surgery №2. In the postoperative period was marked haemodynamic instability with a tendency toward hypotension associated with intra - and postoperative blood loss. 17.11.06, the patient was transferred to the intensive care unit. At the time the patient's condition is extremely serious. The consciousness of the oppressed to spoor. Pale skin, cold. Spontaneous breathing is inadequate, bradypnoea 8 in 1 minute. Pulse on peripheral arteries is not defined, AD - 60, and 30 mm Hg, CVP - negative. Dressing liberally soaked with blood. Analysis: severe anemia - hemoglobin 34 g/l); thrombocytopenia 53,9×109/l; triglycerides - fibrinogen 0.8 g/l, 1,75, APTT, or 48.2 seconds. Diagnosed with acute massive blood loss, posthemorrhagic anemia severe hypovolemic shock, DIC in stage gipokoagulyatsii; hypoxia mixed Genesis. Performed tracheal intubation, IVE started the. Been a large infusion-transfusion therapy, treatment of multiple organ failure. The total amount of transfused plasma 4000 ml; erythromyci and EMEL 2000 ml. during the first day was marked oliguria, was conducted stimulation of diuresis by antispasmodics, saluretics and perfusion solution of Dopamine 1-2 mcg/kg per minute. According to the analysis there was a strong hypoproteinemia 23 g/l; ALT up to 2548; to ACT 4512; creatinine 354 µmol/l; urea 30 mmol/L. Radiographically confirmed rdsw. Mechanical ventilation was performed by servoventilation "Siemens Elema 900" mode VOLUM CONTROL, as stabilization of the patient on the 2nd day translated into AV mode SIMV+press. Support with forced BH-9 per minute, with a 6-day forced BH-4 per minute. Conducted software rehabilitation bronchoscopy 1-2 times per day. To treat ventilation pneumonia were treated according to the proposed method: conducted discrete plasmapheresis in a volume of 400 ml, for paracommandos therapy prepared medicinal mixture by incubating 60 ml of plasma of the patient with Ronkoleykin dose of 500-1 million UNITS, seablom dose of 1 g for 45 min and 37°C. supernatant was injected into the axilla to the right 1 time per day). A total of eight treatments. On the 8th day the patient was transferred to an independent breath, against the background of clear consciousness, satisfactory muscle tone, Stabi who enoy hemodynamics, spontaneous and adequate breathing, positive x-ray dynamics in the lungs, normalization of blood counts, exuberan. On the 10th day transferred to the Department of surgery №2.

Table 7. The mode of plasmapheresis and EFIT the patient Z., 51,, in dynamics

Table 8. Indicators LEAH patient Z., 51 L., dynamics.

The application of the proposed method of detoxification in this clinical observation was also possible to obtain a marked positive effect.

Thus, the proposed method of detoxification through the integrated application of discrete plasmapheresis, lymphotropic extracorporeal farmacoterapia in optimized mode allows to effectively reduce the overall intoxication by the combined detoxification circulating blood, lymph and interstitial spaces. Its application allows you to quickly eliminate the negative influence of endotoxemia on the functioning of the vital organs, systems and the whole organism, which ultimately reduces the mortality and the number of complications.

Table 1
Date/PeriodMorningEvening
13.0637,4 a 38.5
14.0636,638,2
15.0636,337,5
16.0637,636,5
17.0636,636,7
18.0636,536,5

Table 2
Date, indicatorsThe right kidney, mmThe left kidney, mm
13.06117×61111×56
14.06117 x 62110×56
20.06115×45110×48

Table 3
Date/indicators13.0614.0620.0622.06
LEAH units6,09,52,21,5

Table 4
Date/IndicatorsProteinLeukocytes
13.060,03Entirely
14.060,091In large quantity
19.06NegativeSingle

Table 5
DateBlood volumeThe amount of exfuze plasmaEPICThe incubation time, T°C
21.09400 ml200 mlRoncoleukin 1 million IU + Catabol 1 g45 minutes, 37°C
23.09400 ml240 mlRoncq the Lakin 1 million IU + Catabol 1 g 45 minutes, 37°C
24.09400 ml230 mlRoncoleukin 500 thousand ME + Catabol 1 g45 minutes, 37°C

Table 6
Date(day), indicators21.09 (1-e)22.09 (2nd)26.09 (6th)28.09 (8)
LEAH units15,08,02,01,4

Table 7
DateBlood volumeThe amount of exfuze plasmaEPICThe incubation time, T°C
18.11400 ml180 mlRoncoleukin 1 million ME45 minutes, 37°C
19.11400 ml200 mlefamol 1 g 45 minutes, 37°C
20.11400 ml240 mlCatabol 1 g45 minutes, 37°C
21.11400 ml200 mlRoncoleukin 500 thousand ME + Catabol 1 g45 minutes, 37°C
22.11400 ml200 mlRoncoleukin 500 thousand ME + Catabol 1 g45 minutes, 37°C
23.11.400 ml200 mlRoncoleukin 500 thousand ME + Catabol 1 g45 minutes, 37°C
24.11.400 ml190 mlRoncoleukin 500 thousand ME + Catabol 1 g45 minutes, 37°C
25.11.400 ml180 mlRoncoleukin 500 thousand ME + Catabol 1 g45 minutes, 37°C

Table 8
Date (day), indicators17.11 (1-e)18.11 (2nd)20.11 (3)23.11 (7th)
LEAH units5,06,58,51,5

Sources of information

1. The technological basis of in vitro methods hemocorrection. Sokolov A.A., Belsky A.N. (with the participation of Gurevich CA). - P.41, in the book: Efferent therapy - SPb: LLC "Publishing house"Folio", 2003. - 432 S.

2. Kostyuchenko A.L., Belsky A.N., Tulupov A.N. Intensive therapy of postoperative wound infection and sepsis. - SPb: Folio, 2000. - 448 S.

1. The method of detoxification during endotoxemia due to septic conditions, including the removal of the hearth destruction followed by sanitation and drainage, conducting discrete plasmapheresis, characterized in that conduct infostealers therapy by introducing megastate space 60 ml of 0.25%solution of novocaine with dissolved 0.1 g lidz and 1.0 ml of pentoxifylline, 1-3 injections, then discrete plasmapheresis in a volume of 400 ml for the patients and 800 ml in patients with moderate, 1-8 procedures, and infostealers therapy alternate every other day with limpot the Phnom in vitro farmacoterapia, for which prepare medicinal mixture by incubation 40-60 ml of plasma of the patient with ronkoleykin dose of 500-1 million UNITS, seablom dose of 1 g for 45 min at 37°C.

2. The method according to claim 1, characterized in that during peritonitis and peritoneal sepsis drug mixture is injected by bolus in the retroperitoneal tissue.

3. The method according to claim 1, characterized in that when the destructive processes in the pleural cavity of a medicinal mixture injected into the axillary fossa.



 

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2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to experimental surgery, and can be used for correction of ischemic liver affection. For this purpose 2 hours before operation 5% mexicor solution in dose 10 mg/kg of weight is intravenously jet injected to experimental animal. After that one hour before operation actovegin in dose 10 mg/kg of weight is intravenously jet injected. During operation ischemia is created by temporal extracorporal portacaval shunting. In post-operation period each of preparations is introduced 1 time a day during 7 days. Interval between their introduction is 12 hours: mexicor is introduced at 8 o'clock, actovegin - at 20 o'clock.

EFFECT: method ensures reduction of reperfusion disorders, elongation of safe terms of liver exsanguination up to 30 minutes and prevention of massive hemorrhage in operations on this organ.

3 dwg, 4 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery. After abdominal sanation and main stages of the operation, 200 mg of Cyclophosphamide dissolved in 100 ml of physiologic saline is introduced into the area of a deseroused intestine and small pelvis.

EFFECT: invention prevents development of recurrent postoperative abdominal adhesions and postoperative complications.

1 tbl, 2 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to pharmaceutics, more specifically to a pharmaceutical composition for treating pain and/or eye damages during surgical or physical operations or before eye operation, containing a combination of a parasympatholytic agent, a sympathomimetic agent and a local anaesthetic, differing that in the composition, the parasympatholytic agent concentration is 0.015 to 0.025%, the local anaesthetic concentration is 0.75 to 1.25% and the sympathomimetic agent concentration is 0.2 to 0.4%.

EFFECT: invention provides rapid and prolonged anaesthesia, and also stable pupil dilatation for examination and surgical operation.

7 cl, 4 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to combustiology and can be used in preparing donor skin sites before drawing grafts in skin grafting. That is ensured by introduction of ozonised physiologic saline with ozone concentration 160-200 mcg in subcutaneous fat of a donor site. Introduction is performed 10-15 minutes prior to cutting the grafts in amount 150-200 ml.

EFFECT: method ensures considerable reduction of time of donor wound epithelisation due to improved microcirculation that allows reusing donor sites.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine notably to the field of surgery and may be used for general peritonitis treatment. For it abdominal cavity is irrigated with ozonised physiological solution of sodium chloride with concentration 20 mcg /ml and then is drained. Then in right and left hypochondriums and right and left iliac regions drainage tubes with ultrasonic sources are installed. Then ultrasonic vibration is measured in the middle level of abdominal cavity. If ultrasonic vibration is less than 500 kHz additional drainage tubes with ultrasonic sources are installed in right and left side channels of abdominal cavity. No more than 1 litter of the above mentioned ozonised physiological solution is infused in every drain tube daily. Besides continuous 500 kHz ultrasonic exposure is prescribed for the 1st-4th days and continuous 400 kHz ultrasonic exposure is prescribed for the 5th-7th days of therapy.

EFFECT: method provides the most effective abdominal cavity sanation thanks to steady and simultaneous abdominal cavity ultrasonic exposure in combination with bactericidal effect of ozonised solution in specified regime.

1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to obstetrics and gynaecology. The method for prevention of adhesive process in peritoneal cavity in obstetric-gynaecologic surgeries involving administration of chitosan compounds and differing that the compound is applied in layer-by-layer suturing of an operative wound in preperitoneal and skin structure of anterior abdominal wall. The compound represents a sponge measured 60×100×4 mm to 240×180×4 mm and containing 2% collagen acetate, 2% chitosan ascorbate of degree of deacetylation 95% and more, molecular weight 100 to 700 kDa, ascorbic acid - 1.8 g/g of dry chitosan, chondroitin-sulphuric acid - 5-100 mg/g of dry chitosan, hyaluronic acid - 10-100 mg/g of dry chitosan, heparin - 2.5-5 mg/g of dry chitosan and bovine serum growth factor "Adgelon" - 11-220 mkg/g of dry chitosan.

EFFECT: method improves effectiveness of prevention of postoperative adhesive process in small pelvis in women, prevents development of exudative processes in the operative wound tissues and accelerates the healing.

2 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: in treatment of children with pyoinflammatory diseases with possibility of development of local necrotic and septicopyemic complications deeply subcutaneously enoxaparin (Klexane) is introduced in amount 0.5 mg/kg of body weight. Introduction is performed 1 time a day during all acute phase of inflammation.

EFFECT: method allows to increase treatment efficiency due to reduction of blood clot formation in lesion focus resulting from introduction in individually selected dose and in definite phase of disease of low-molecular heparin preventing in this way disease complications in children.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dermatology, and can be used for treating patients with psoriasis. Method includes drug therapy with application of hyposensibilising anti-histamine medications, hepatoprotectors, vitamins, local exfoliating and releasing ointments, general ultraviolet oirradiation. Method also includes plasmapheresis with division of blood into plasma and erythrocyte mass by centrifugation with removal of patient's plasma and erythrocyte mass reinfusion. Before returning erythrocyte mass into patient's organism it is processed with 200 ml of ozonised physiological solution with ozone concentration 2.5 mg/l. After that reinfusion of ozonised erythrocyte mass is carried out.

EFFECT: method allows to increase efficiency of psoriasis treatment due to reduction of PASI index level, correction of disturbed indices of hemostasis and lipid exchange.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and can be used in contraction of anaemia accompanying the chemoradiation therapy. That is ensured by blood exfusion in amount 8-10% of the circulating blood volume, and the removed blood volume is replaced with crystalloids in the ratio 1:1. From the exfused blood, erythrocyte concentrate is recovered whereto Essentsiale N solution 5 ml is added; the prepared mixture is placed in a thermostat at temperature 37°C for 10 minutes. Then 100 ml of a physiologic saline is added to said mixture that is rocked. The prepared solution is introduced to the patient within 20 minutes with a simultaneous UV blood irradiation. Exfusion and extracorporal blood processing combined with UV irradiation are performed every second day, 2-3 sessions for the therapeutic course.

EFFECT: method allows reducing time for normalisation of the blood erythrocyte level and haemoglobin with maintaining the time intervals for chemoradiation therapy courses and without reducing the dosage of chemopreparations and radiation tumour load.

2 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to gynaecology and urology, and concerns treating chronic recurrent urogenital bacterial and viral infections. That is ensured by producing lymphocyte self-cells of the patient's blood. Then said lymphocytes are cultivated with an immunomodulator. It is followed with intrauterine introduction of 0.5-2.0 ml of a lymphocyte suspension in an acceptable medium at their concentration 106-107 cel/ml.

EFFECT: without using antibacterial preparations, method provides evident antiviral and antibacterial effects, normalisation of the immune status with minimum by-effects.

5 cl, 4 ex, 3 tbl

FIELD: medicine.

SUBSTANCE: treatment of the patients with chronic heart disease and obliterating atherosclerosis of lower limb is ensured by a course of plasmapheresis consisting of 5-6 sessions every 3-5 days. Each session starts with introduction of 50-60 ml of physiologic saline and removal of 300 ml to 900-1200 ml of plasma prepared by centrifugation in a cold centrifuge at rotary speed 1500-1800 rpm and temperature +4 ° - + 6°C within 15-20 minutes. Plasma is compensated with physiologic saline at the ratio 1:1. The course involves gradual increase of the volume of removed plasma starting with the minimal amount in the first session to the maximal amount to the middle and following decrease of this volume to minimum by the end. Total amount of removed plasma is 1-1.5 volumes of circulating plasma.

EFFECT: method allows administering out-patient continuous treatment of said group of the patients, including in case of resistance to drug therapy.

4 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: there are offered device and method used to identify and recover various blood-dissolved particles of biological origin and biomolecules from liquids with applying suitable carriers and common immobilisation techniques. The device can be used both for discontinuous, and for direct and continuous processing of liquids.

EFFECT: background of the invention involves application in animals, biotechnology, including biological tests, and clinical diagnostics.

12 cl, 11 dwg

FIELD: medicine.

SUBSTANCE: invention concerns medicine, oncogynaecology. The method involves blood sampling, mixing thereof with oxygen-ozone gas mixture and the following reinfusion thereof. One session involves sampling of 70-120 ml of blood thereafter mixed with 200-250 ml of oxygen-ozone mixture of ozone concentration 5-10 mg/l. Blood reinfusion is followed with introduction of preparation Cernevit in amount 5 ml. Therapeutic course is 10-14 sessions.

EFFECT: method improves clinical effectiveness ensured by stimulation of antioxidant system, normalisation of metabolic processes, hormone-vegetative and immune status of an organism.

4 ex

FIELD: medicine.

SUBSTANCE: to treat patient suffering from hepatitis B or C, body fluid is sorbed by means of flowing through device comprising suspension preparation assembly equipped with ultrasonic dispergator wherethrough nanoparticle suspension shall flow as nanofraction of cobalt ferrospinel CoFe2O4 in spiritus and shall be mixed with body fluid infected by viruses of hepatitis B or C. The device also comprises magnetic filter with entry zone wherein a uniform magnetic field is established rough filtration zone where gradient magnetic field is established from axially magnetised bushing, fine filtration zone wherein alternating high-gradient magnetic field is established. Body fluid, which is free from nanoparticles with sorbed viruses is delivered into vessel for clean body fluid accumulation.

EFFECT: inventions enable to improve sorbtion efficiency relative to antigens and viruses over a wide range of concentrations and concentration weakening in sorbing solution below the limit of poor and positive reaction.

9 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to fields of surgery and resuscitation science and can be used in treatment of patients with acute destructive appendicitis, confirmed intra-operatively. Draining of right iliac fossa or tamponade and draining of right iliac fossa are performed and anti-bacterial therapy is carried out. In case of performing appendectomy by traditional or laparoscopic method, polyethylene catheter is installed in retroperitoneal space into right iliac fossa, through which additionally introduced is roncoleukin, incubated during 60 minutes at temperature 37°C with obtained by plasmapheresis patient's leukosuspension in amount 70-80 ml on 1,3,5 day of post-operation period.

EFFECT: method allows to increase local immunity, realise prophylaxis of suppurative complications in case of acute destructive appendicitis.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used for post cosmetic surgery rehabilitation that is ensured by introduction of mixed medicinal preparations in lymphoid region of orbit, namely within pterygopalatine fossa and parotid. The mixed preparations introduced in pterygopalatine fossa are lidocaine 50-100 mg, dexamethasone 4-8 mg, glucose 400-800 mg, dalargin 1-2 mg and Lydasa 16-32 UN. And parotid injection contains lidocaine 50-100 mg, aminophylline 24-28 mg, hystochrom 10-20 mg and Lydasa 16-32 UN. Introduction of the mixed preparations is carried out on right or left side of face alternately every 4-5 hours daily within the course 6-8 procedures. Then 3-5 procedures of discrete plasmapheresis follow with using no more than 20-25% of total blood volume for exfusion. The prepared cell mass is incubated with 250-350 cm3 of ozone-oxygen mixture of ozone concentration 3000-3200 mkg/l.

EFFECT: method allows reducing post cosmetic surgery rehabilitation time owing to stimulation of regional lymph flow ensured by high local concentration of medical preparations.

2 ex

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely to neurology, and can be used for treatment of a chronic fatigue syndrome. For this purpose hemosorption and plasma depletion are performed in the form of the alternating procedures accompanied with exfusion of 5-7% of volume of circulating blood. The procedures are alternated under the scheme: 1st day of the cycle - hemosorption, 6th day of the cycle - plasma depletion, 12th day of the cycle - hemosorption, 18th day of the cycle - plasma depletion.

EFFECT: rising of efficiency of treatment, depression of frequency of relapses, improvement of quality of a life of patients at the expense of occurrence as a result of treatment of the compensatory mechanisms promoting homing of system regulation of an organism to physiological norm.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to experimental medicine and concerns preparation of a cell transplantation material in myelosuppression. That is ensured by subcutaneous introduction to a laboratory animal of a recombinant granulocytic colony-stimulating factor (G-CSF) in dosage 125 mcg/kg once a day for 3 days. It is combined with intraperitoneal introduction of hyaluronidase in dosage 1000 SU/kg once a day for 2 days. Then mononuclear leukocyte fraction of peripheral blood is prepared, placed in a balanced nutrient medium containing 10-8 mol/ml of D-glucuronic acid, and incubated for 2 hours.

EFFECT: introduction of G-CSF and hyaluronidase in the developed dosage and regimen, in combination with incubation with D-glucuronic acid added provides higher therapeutic activity of the graft due to mononuclear growth in peripheral blood and better engrafting ability.

1 ex, 4 tbl

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