MODIFIED PLASMAPHERESIS IN THE TREATMENT OF PATIENTS WITH LIVER PATHOLOGY

B.A. SAIDHANOV, A.R. GUTNIKOVA, M.T. AZIMOVA , M.M. ALIMOV
I.V. KOSNIKOVA

Republician Surgical Centre after acad. B. Vakhidov, Tashkent, UZBEKISTAN

Introduction. The number of chronic liver diseases has been increased recently. It is connected with unfavorable environmental conditions, increasing of the toxic load on the liver, both drugs and alcohol, and, mainly, with the increasing of the incidences of viral hepatitis, often accompanied by hepatic failure with severe endogenous intoxication syndrome.

The purpose of the study is clinical evaluation of a new technique of plasmapheresis in complex treatment of patients with viral hepatitis complicated by hepatic insufficiency.

Materials and methods. We observed 13 patients with viral hepatitis complicated by liver failure that need detoxification. Patients were treated with plasmapheresis sessions, conducted by the developed technique, consisting in the aggregation of membrane plasmapheresis with oxidative detoxification. In contrast to the standard technique, a new method does not need prior administration of heparin, which is replaced by neutral anolyte. Efficacy of the treatment was assessed by changes in physical and clinical status of patients and verified changes in laboratory indices of endotoxemia. The control group included 7 patients, treated with plasmapheresis in standard procedure,.

Results and discussion. After plasmapheresis all patients in the initial state had clear signs of endotoxemia with symptoms of liver failure. As a result, a study has shown a positive dynamics of the pathologic process in all patients, regardless of the tactics of plasmapheresis (PA), however, the achievement of significant reduction or normalization of the studied parameters required a different number of sessions. After the completion of detoxification a significant reduction of almost all investigated parameters were achieved in patients of both groups. However, the trend towards normalization was more pronounced in patients of the experimental group, who needed fewer sessions of PA that indicates to a marked reduction in the level of CM. Conducting plasmapheresis on modified method has revealed its superiority over the traditional method. Replacement of withdrawn plasma with neutral anolyte has allowed us to solve several problems simultaneously. First, as with other salt solutions, the introduction of NA starts a compensatory mechanism for restoration of plasma volume through the mobilization of interstitial and intracellular water spaces that causes the enter of substances, causing toxemia, into circulation. This is confirmed by the restoration of abnormal concentrations of blood products in just a few hours after the first session. Therefore, this requires subsequent sessions. But, in contrast to conventional solutions, NA has a more pronounced rheocorrecting effect , it can actively influence the microcirculation and provides a more complete washout of abnormal substances, deposited in the tissues, thereby reducing the number of sessions.

Thus, the change of the way of conducting of PA by its combination with NA allows to affect simultaneously on a wider range of endotoxins, as well as micro-organisms, including viruses, that greatly increases the opportunities of detoxification technique and increases its efficiency.

THE EFFICACY OF APPLICATION OF HAEMOSTATIC MATERIAL OF THE LOCAL RAW IN LIVER OPERATIONS IN EXPERIMENT

B.A. SAIDHANOV, D.N. DALIMOV, M.M. ALIMOV,

A.B. TURAKULOV, Sh.K. NIGMATOV

Republician Surgical Centre after akad.V. Vakhidov, Tashkent, UZBEKISTAN

Today, there exists a plenty of local hemostatic materials which are widely used both in surgical and domestic practice when stopping minor bleeding from abrasions, cuts, wounds, etc.

Powders, pellicles, sponges, gels are the most convenient materials to stop local bleeding. Known import hemostatic agents have a high hemostatic activity. Unfortunately, the cost of these hemostatic means is high enough, that indicates a need for effective domestic hemostatic funds from local raw materials.

Purpose: To examine and give an experimental verification to the possibility of using of hemostatic substances on the basis of local raw materials for stopping the parenchymal bleeding.
Materials and Methods: The local hemostatic agent in the form of a collagen pellicle is a supramolecular complex of lagohilin (natural diterpinoid with hemostatic activity) with monoammonian salt of glitsirizinic acid. Experimental studies of specific activity were conducted on a model of parenchymal hemorrhage (traumatic bleeding from liver, abnormal liver resection). We put to use rats of «Vistar» breed – 12, rabbits of "Shinshella" breed - 10 and purebred dogs – 6, in whom on the 7-th, 14-th and 21-st days after the application of hemostatic pellicle for stopping the bleeding were taken slices from organs for morphological study and blood for estimation of clinical-laboratory changes.

Results: The mechanism of haemostatic effect of the drug is related to its effects on vascular-platelet hemostasis, the increase of a number of adhesive-aggregation ability of platelets in blood. Along with activation of platelet system takes place a decrease of capillary permeability, which leads to increased retraktivity of the formed clot. It stops bleeding in experimental animals for 1.5-2.0 minutes. This drug belongs to the VI Class of practically non-toxic compounds.

Conclusion: A new hemostatic material in the form of a collagen pellicle can be used to stop parenchymal bleeding in trauma and blood loss operations. It has no local-irritating and allergic actions. The pellicle has no toxic effect on peripheral blood, kidneys and liver.

Date: 2014-12-28; view: 1069