[Extracorporeal detoxication in combined therapy of pancreonecrosis]. / Ekstrakorporal'naia detoksikatsiia v kompleksnom lechenii pankreonekrozov.

Extracorporeal detoxication methods (hemofiltration, discrete exchange and filtration plasmapheresis) were added to intensive care complexes for 53 patients with pancreonecrosis. Peritonitis with multiple organ dysfunction was diagnosed in all patients. The severity of intoxication, central hemodynamic parameters, blood gaseous composition were evaluated in the monitoring regimen. Oxygen transport and consumption were estimated. Pancreonecrosis was paralleled by severe endogenous intoxication. Hemofiltration led to a stable decrease in the level of pancreatogenic toxicosis in the majority of patients. Combination of hemofiltration and plasmapheresis led to a more rapid and effective elimination of creatinine, bilirubin, and amylase without essential changes in the electrolyte composition. Clinical symptoms of acute respiratory and cardiac insufficiency decreased, central hemodynamics and oxygen transporting function of the blood improved. Combination of hemofiltration and plasmapheresis mutually potentiated the positive effects of both methods and extended the potentialities of filtration methods in replacement of organ dysfunctions in multiple organ dysfunction.

[Hemodynamics and oxygen transport in patients with surgical sepsis during hemofiltration]. / Gemodinamika i transport kisloroda u bol'nykh s khirurgicheskim sepsisom pri provedenii gemofil'tratsii.

Effects of hemofiltration (HF) on central hemodynamics and oxygen transport are studied in 35 patients with surgical sepsis and multiple organ failure. HF is paralleled by development of hypovolemia and decrease of myocardial contractility, determining a decrease in cardiac output and oxygen transport. As a result, oxygen utilization by tissues decreases and hypoxia progresses. The only compensatory mechanism of oxygen supply in such patients is maintenance of cardiac output, which should be borne in mind when carrying out HF.