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Extracorporal methods of detoxication and peritoneal dialysis
Of the extracorporal methods of detoxication the most effective is hemodialysis. Indications for hemodialysis in ARF are: — hypervolemia manifested by cardiac insufficiency; — hyperkalemia in K+ content in plasma 6.5 mmol/1 and higher; — anorexia, nausea, vomiting, elevation of neuromuscular excitability, delirium, pericardial murmur; — elevation of urea nitrogen level over 35 mmol/1 or its daily increase by 5 mmol/1; — metabolic acidosis not yielding to correction. Plasmapheresis — discrete or apparatus. In the process it is necessary to remove no less than 1200 ml of plasma that requires its replenishment with colloid solutions. Blood drawing is carried out in the same way as taking fresh heparinized donors' blood. 100 ml of physiological solution with 5000 U heparin per every 400 ml of blood are introduced in the removed blood. Blood is left to settle or centrifuged; plasma is removed and packed red cells are returned into the patient's vascular bed. This method is extremely simple and available in any medical institution. Hemosorption is a method of detoxication of the organism with the help of activated charcoal and ion exchange resins. In Ukraine the most prevalent are coal sorbents SKN and SUGS. They possess high efficiency, do not cause a decrease of thrombocytes' level and erythrocytes hemolysis, contribute to clearance of creatinine, urea, substances with medium molecular mass, bilirubin, ammonia and phenols. A procedure of carrying out hemosorption is rather simple and available, practically, to all medical institutions having a roller pump, however, hemosorption is not able to replace hemodialysis, since it cannot correct WEE and AAB. A combination of plasmapheresis and hemosorption may prove to be rather effective at the 2-nd stage of ARF to preserve patient's life. Peritoneal dialysis — it is a method of extrarenal intracorporal blood clearance in which a sterile dializing solution is introduced into the abdominal cavity by portions or running through a fistula in the anterior abdominal wall. Peritoneum serves as a dializing membrane through which about 1200 ml of blood circulate per min. A clearance of contemporary peritoneal dialysis by urea does not yield to hemodialysis and by «medium-size molecules» exceeds it twice. At the stage of polyuria a treatment must be directed to the maintenance of water-electrolyte balance, AAB and fight against infection, anemia, as well as a decrease of protein catabolism. At present, it is generally accepted that such procedures as renal decapsulation, paranephral blockades are harmful in ARF. Surgical methods of ARF treatment are applied in the subrenal form and directed to elimination of obstacles to urine passage and blood flow of the kidneys. Дата добавления: 2015-02-05 | Просмотры: 957 | Нарушение авторских прав |