ABSTRACT
This study was carried out for improvement of extracorporeal detoxication results. Distribution of middle-mass molecules (MM) in various media and vascular beds in patients with acute general peritonitis (AGP) and correlation between central hemodynamics (CH) and level of MM-intoxication were studied. Results of treatment were analyzed in 72 patients with AGP. Ultraviolet irradiation of autoblood (UVIA) had negative influence on circulation in patients with AGP in terminal stage who had more severe primary disorders of CH. Therefore, UVIA without hemosorption (HS) in these patients is potentially dangerous because of undesirable hemodynamic effects due to increase of MM-concentration in blood plasma. HS was performed 1.5-2 hours after UVIA and resulted in decrease of MM-concentration in caval system blood by 28.1% with subsequent slow increase, MM-level restored 24 hours after HS. If HS and UVIA were carried out simultaneously, MM-concentration in caval system blood decreased by 13.9% only, an in 3 of 7 cases MM-concentration didn't change. Combination of UVIA and HS with 1.5-2 h interval is most effective.
Subject(s)
Albumins/therapeutic use , Peritonitis/complications , Peritonitis/therapy , Plasma Substitutes/therapeutic use , Sorption Detoxification/methods , Toxemia/complications , Toxemia/therapy , Ultraviolet Therapy/methods , Acute Disease , Blood/radiation effects , Dextrans/therapeutic use , Endotoxins , Hemodynamics , Humans , Peritonitis/drug therapy , Time FactorsABSTRACT
Taking into account the processes of deposition of toxins in conditions of disturbed microcirculation in syndrome of endogenous intoxication (SEI) in patients with acute diffuse peritonitis (ADP) of various origin, the authors consider determination of concentration of the medium-molecular (MM) toxins only in blood plasma rather uninformative. They suggest simultaneous determination of them in various biological substanees of patients with ADP (blood from various vascular beds, peritoneal exudate, hymus, urine), which makes it possible to reveal basic stages of kinetics of the medium-size molecules in extracorporeal detoxication.
