Body detoxification procedure

FIELD: medicine.

SUBSTANCE: first, Fraxiparine is inhaled for 5-10 minutes. A dialysis solution for peritoneal dialysis containing extranyl is administered into the abdominal cavity 1-1.5 hours later through a catheter. The solution additionally contains: albumin in the concentration of 35-40 g/l, heparin in the concentration of 500-750 Unit/l and papaverine in the concentration of 50-100 mg/l. Every 6-8 hours after the beginning of exposure of the dialysis solution in the abdominal cavity, the Fraxiparine inhalations are repeated. The time of a single exposure of the dialysis solution in the abdominal cavity makes 12-18 hours.

EFFECT: method provides effective body detoxification in the given category of patients by providing a high toxin clearance owing to a continuous high osmotic concentration of the solution and the dilatation of pre-capillary peritoneal arterioles, prevented inspissation of the albumin solution to the colloidal state and its inactivation that reduces a rate of the dialysis solution exchanges.

3 ex

 

The invention relates to the field of medicine, to methods intracorporeal detoxification, and can be applied in stationary conditions.

One of the most common methods of detoxification is peritoneal dialysis (BT the Bikbov, N.A. Tomilin. Nephrology and dialysis. - 2011. - V.13. No. 3, s).

It is known that the possibility of applying this method of detoxification can be significantly limited as a result of the development of dialysis peritonitis, due to the need 4-5-fold replacement solution in the abdominal cavity and the associated high risk of infection dialysis solution, and frequently overweight patients, as well as features of the transport properties of the peritoneum, causing treatment failure peritoneal dialysis.

The closest is a way of detoxifying used in the treatment of kidney and liver failure, as well as endo - and exogenous intoxications, including peritoneal dialysis performed by introduction through the catheter into the abdominal cavity of the dialysis solution containing albumin in a concentration of 65-75 g/l and Fraxiparine 0,3-0,6 ml; the latter 2 components are pre-mixed together in 3-5 minutes, and then through the infusion system is introduced into a standard dialysis solution, PR is varicella warmed up to t 38-40C. Exposure of this solution into the abdominal cavity occurs within 5-7 hours (RF Patent 2325194, IPC A61M 1/28, publ. 2008).

The disadvantages of this method include the risk of dialysis peritonitis and high cost of implementation due to the impossibility prolonged exposure dialysis solution and the need for 4-6-fold replacement dialysis solution into the abdominal cavity, which leads to increased risk of infection and the emergence of dialysis peritonitis.

The objective of the proposed method is to increase the efficiency of detoxification of the body by applying the composition solution for peritoneal dialysis, reduction in the incidence of dialysis peritonitis due to a significant reduction in the number of exchanges of dialysis solution, and improving the quality of life and survival of patients; reduction in the cost of treatment patients receiving treatment for peritoneal dialysis; reduction in bed-days due to the quick effect of dialysis therapy.

The task in the way of detoxification is due to the fact that first made by the inhalation of fraxiparina for 5-10 minutes. Then after 1-1,5 hours exercise introduction through the catheter into the abdominal cavity of the dialysis solution for peritoneal dialysis containing EXTRANEAL, in which BB is completed with albumin at a concentration of 35-40 g/l, heparin at a concentration of 500-750 IU/l papaverine at a concentration of 50-100 mg/L. thus every 6-8 hours after start of exposure dialysis solution into the abdominal cavity again inhalation of fraxiparina. During a single exposure dialysis solution into the abdominal cavity 12-18 hours.

That apply this dialysis solution provides high ground clearance of toxins through maintaining a constant high osmolarity of the solution, as well as dilatation precapillary arterioles peritoneum. This also contributes to the long exposure time of the proposed solution in the abdominal cavity. Inhalation of fraxiparina and content of heparin in solution to prevent the precipitation of albumin to a colloidal state and its inactivation. Reduces the number of exchanges of dialysis solution 2-6 times, namely up to 1.5-2 times per day.

The proposed method intracorporeal detoxification and characteristics that distinguish it from known, in the medical and patent literature is not found.

The method is as follows.

Is inhalation introduction of fraxiparina for 5-10 minutes in 1-1,5 hours, followed by infusion through the catheter into the abdominal cavity of the dialysis solution, mainly within the 2 liter Solutions of albumin, heparin and papaverine mixed between the Wallpaper in 3-5 minutes, and then through the infusion system is injected into dialyzing solution - EXTRANEAL. Exposure of this solution into the abdominal cavity occurs within 12-18 hours.

The proposed method was successfully applied in the Department of transplantation, Nephrology and surgery hemocorrection.

The implementation of the method is demonstrated on specific clinical examples.

Example 1

Patient D., born in 1981, was admitted to the hospital with a diagnosis of poisoning with alcohol substitutes. Acute renal failure, anuria stage.

Upon receipt marked edema of the lower extremities, puffiness of the face, arterial hypertension, evidence of severe overhydration. Creatinine was 900 mol/l, urea - 34 mmol/l, the critical hyperkalemia - 6.8 mmol/L.

Extra implantation of peritoneal catheter initiated treatment of peritoneal dialysis on the proposed method: in 2.0 l of 7.5% solution of EXTRANEAL put 1500 IU of heparin solution, 200 mg of a solution of papaverine and 80 g of albumin. The prepared solution was injected into the abdominal cavity of the patient within 1 hour after inhalation of fraxiparina within 5 minutes (repeated inhalation was performed every 6 hours). Dialysate drained after 12 hours in the volume of 3.1 l, controlled completely hyperkalemia. Repeated infusion of a solution with the same composition.

Chere is C day treatment peritoneal dialysis has managed to significantly reduce the overload, to reduce the creatinine level up to 450 mmol/l, urea to 20.3 mmol/L. Subsequently, the treatment of peritoneal dialysis in the same pattern held for two weeks until full recovery of renal function.

It should be noted that as a result of treatment the patient's proposed method of peritoneal dialysis managed to achieve restoration of diuresis after 2 weeks, which is considerably less than when using the standard treatment. This is due to effective detoxification and relief of factors contributing to necrosis of the renal tubules.

Was discharged in good condition after 17 days.

Example 2

Patient O., born in 1970, was in outpatient treatment with a diagnosis of diabetes mellitus, type 2, insulin, asthma, heavy flow. Diabetic nephropathy. Diabetic angio-retinopathy. Chronic renal insufficiency, end-stage. Continuous ambulatory peritoneal dialysis.

Was admitted to hospital because of the development of dialysis peritonitis. Conducted antibacterial therapy. When examined, among other complications were identified deterioration of the transport properties of the peritoneum, which was reflected in the failure of ultrafiltration, reducing weekly index of the adequacy of treatment of peritoneal dialysis Kt/V of 1.2, as well as red eye reduction the Sri index weekly creatinine clearance up to 42 HP

In order to achieve effective treatment peritoneal dialysis was used in the proposed method: pre-prepared solution containing 2.0 l of a solution of EXTRANEAL, a solution of heparin in a dose of 1200 IU, albumin, 70 g, the solution of papaverine 150 mg

1.5 hours after inhalation of fraxiparina within 10 minutes, the mixed solution is introduced into the abdominal cavity 18 hours, repeated inhalation of fraxiparina was performed every 8 hours.

As a result of treatment under the scheme for 1.5 weeks on a background of antibacterial therapy were able to achieve edema dialysis peritonitis, terminate overload, increase weekly index, Kt/V to 2.3 and weekly creatinine clearance up to 75 litres per week, which contributed to the achievement of the necessary dose of dialysis.

The patient was discharged to outpatient treatment after 12 days.

Example 3

Patient T., born in 1963, in connection with the transferred dialysis peritonitis observed treatment failure peritoneal dialysis according to the standard schema.

Therefore, it was decided to conduct the treatment by the proposed method with the use of a new dialysis solution.

Inhalation of fraxiparina for 7 minutes, followed after 1 hour by infusion into the abdominal cavity 2.0 l of EXTRANEAL with the addition of the solutions in the concentration of albumin 80 g of papaverine 100 mg/l, gaari is and 500 IU/L. Inhalation of fraxiparina repeatedly carried out every 7 hours. After 14 hours was drained dialysate in a volume of 3.5 liters To treat peritoneal dialysis under the proposed method, the serum creatinine was 1.25 mmol/l, urea 32.5 mmol/l after treatment - 0.65 mmol/l and 12.3 mmol/l, respectively.

The treatment in this way was carried out within 3 weeks, this was achieved prolonged use of peritoneal dialysis for conversion to hemodialysis without additional unscheduled medical measures to prolong hospitalization and extended periods of rehabilitation patients.

In General, application of the developed method of peritoneal dialysis in 82 patients made it possible to improve the results of the application of peritoneal dialysis by reducing the time of recovery of renal function in acute poisoning and acute renal failure due to effective detoxification.

The method allows to prolong the treatment of peritoneal dialysis in chronic renal failure, improve the quality of life and survival of patients with dialysis peritonitis, to reduce the number of bed-days, and to increase the economic efficiency of the treatment of these categories of patients.

The way de is oxical body, including peritoneal dialysis is injected into the abdominal cavity of the dialysis solution, which is injected albumin, the introduction of fraxiparina, characterized in that as a dialysis solution using EXTRANEAL, while albumin injected into the dialysis solution at a dose of 35-40 g/l, optionally add heparin at a dose of 500-750 IU/l and papaverine in a dose of 50-100 mg/l, exposure dialysis solution into the abdominal cavity is carried out for 12-18 hours, and Fraxiparine administered by inhalation for 5-10 minutes for 1-1,5 hours before the introduction of the dialysis solution, and then every 6-8 hours after start of exposure dialysis solution into the abdominal cavity.



 

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