RESUMO
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.
Assuntos
Hemofiltração , Insuficiência de Múltiplos Órgãos/terapia , Pancreatopatias/terapia , Plasmaferese , Adolescente , Adulto , Idoso , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Necrose , Consumo de Oxigênio , Pâncreas/patologia , Pancreatopatias/diagnóstico , Pancreatopatias/patologia , Resultado do TratamentoRESUMO
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.
Assuntos
Hemodinâmica , Hemofiltração , Oxigênio/metabolismo , Peritonite/cirurgia , Sepse/terapia , Adolescente , Adulto , Idoso , Circulação Sanguínea , Volume Sanguíneo , Débito Cardíaco , Interpretação Estatística de Dados , Humanos , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Insuficiência de Múltiplos Órgãos/terapia , Contração Miocárdica , Peritonite/complicações , Peritonite/terapiaRESUMO
The arteriovenous difference in the values of plasma and its main ingredients' osmolality and hemostasis were examined in patients with grave combined injuries complicated with the adult respiratory distress syndrome (RDS) in the posttraumatic period. The findings showed a changed trend of arteriovenous difference in the osmotic homeostasis parameters in comparison with those during on uneventful course of combined injury: a-v Dosm. in stage IV RDS is (-)22.9 +/- 13.5 mosm/kg H2O versus 3.36 +/- 3.51 mosm/kg H2O in an uncomplicated course (p < 0.001). The arteriovenous difference for plasma COD was 8.1 +/- 3.0 mm Hg and (-)0.5 +/- 0.7 mm Hg in an uncomplicated course (p < 0.001). These changes permit a conclusion about the impaired osmolality regulating function of the lungs in RDS. Analysis of the arteriovenous difference of hemostasis once again confirms the presence of disorders in the hemostasis regulating function of the lungs: the arteriovenous difference of the structural and chronometric values of thromboelastogram is inverted, which indicates an increase of the coagulation potential of arterial blood: the a-v is equal to difference of blood clotting time 48 h after the injury and is (-)0.1 +/- 0.04 min, in contrast to the uneventful course: 2.5 +/- 0.27 min (p < 0.01): the a-v equal to the coagulation index difference was 2.26 +/- 0.49 arb. U, in contrast to (-)2.0 +/- 0.13 arb. U in an uncomplicated course of heating. Disorders in the other than respiratory functions of the lungs develop 11 h earlier than clear-cut x-ray signs of RDS appear, which gives us grounds to consider these changes as the earliest diagnostic criterion of RDS.