RU2269363C1 - Method for treating hepatic failure - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the present innovation deals with the ways of extracorporal detoxication and treatment of hepatic failure. The method should be implemented due to introducing albumin-containing solution through a catheter into abdominal cavity at concentration of 30-40 g/l as dialyzing liquid for 2-4 h. This solution should be purified through "Artificial kidney" apparatus, coal sorbent and anion-exchange resin. Perfusion rate of albumin-containing solution in the course of its purification corresponds to 20-30 ml/min. Detoxication cycle with the help of albumin followed by its deligandization should be repeated many times. The innovation provides optimal mode of perfusion and, thus, high rate of toxins elimination through patient's peritoneum and excludes the necessity in applying anticoagulants and expensive "MARS" system.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to methods of extracorporeal detoxification and can be applied under stationary conditions.

One of the main methods of extracorporeal detoxification in renal failure is peritoneal dialysis. It provides the removal from the patient's body of uremic toxins - substances of mainly low molecular weight, absent in the dialysis solution [Armstrong VW, Fuchs C, Scheler F. - 1980].

The disadvantage of peritoneal dialysis is that it cannot remove toxins associated with proteins or cellular elements of the blood, which occurs with liver failure. The use of sorption and other methods of extracorporeal hemocorrection for these purposes is limited by their small detoxifying ability and a large number of complications.

The closest prototype is the method used in the molecular, adsorption, recirculation system ("MARS"). With this method, the patient’s blood is passed through a MARS filter with a synthetic semipermeable membrane. And as a dialysis fluid, an albumin solution is used, which allows you to transfer toxins, such as bilirubin, bile acids, tryptophan phenols, etc. from the patient’s blood through the MARS filter membrane into the dialysate using the forces of chemical and physical interaction with albumin [Cheger S .AND. 1975]. After passing through the MARS filter, the albumin solution is purified by passing it through the dialyzer of the artificial kidney apparatus, activated carbon and anion exchange resin and is returned to the MARS filter [Steffen R. Mitzner, J. Stange, S. Klammt, ea - 2000]. The process is carried out continuously for 6-8 hours.

The disadvantage of this method, in addition to high cost and limited effectiveness are: the need for blood recirculation in the extracorporeal circuit and the introduction of anticoagulants, which in some cases leads to complications, such as hemodynamic disturbances, bleeding, and dialyzer thrombosis.

The objective of the proposed method is to increase the efficiency of detoxification and patient safety through the use of the peritoneum and the absence of factors affecting hemodynamics and hemostasis, as well as reducing the economic cost of the procedure, since there is no need for an expensive MARS filter.

The objective of the method for the treatment of liver failure, including the use of a solution of albumin as a dialysis fluid, followed by purification through an artificial kidney apparatus, a carbon sorbent, anion exchange resin and repeated detoxification cycles using albumin and its subsequent deligandization, is achieved by removing Albumin-bound toxins from the patient’s body are produced through the peritoneum by introducing a solution containing 30-40 g / l a through the catheter into the abdominal cavity bumina, with its exposure for 2-4 hours and subsequent removal from the abdominal cavity, wherein the perfusion rate of albumin is about 20-30 ml / min. The cycle is repeated many times during the day, after which the albumin solution, artificial kidney dialyzer, sorbent and anion exchange resin are replaced.

The proposed method for the treatment of liver failure, as well as its signs that differ from the known ones, are not found in the medical and patent literature.

The essence of the proposed method for the treatment of liver failure is that the removal of albumin-bound toxins from the body is performed through the peritoneum by introducing through the catheter into the abdominal cavity a solution containing albumin at a concentration of 30-40 g / l, with its exposure for 2-4- x hours and subsequent removal from the abdominal cavity, while the perfusion rate of albumin in the regeneration system is 20-30 ml / min. It is the content of albumin in the physiological range of 30-40 g / l that minimally damages the peritoneum and at the same time provides a relatively high rate of elimination of toxins, the perfusion rate of 20-30 ml / min through the regeneration system provides the most complete and relatively quick cleaning. The decrease in bilirubin at the outlet of the regeneration systems at a speed of 20 ml / min is 86%, at a speed of 30 ml / min - 80%. At a speed of less than 20 ml / min, a slight increase in the quality of cleaning is accompanied by a significant increase in its duration - more than 2 hours of time are spent on regeneration, and at a higher speed, the cleaning performance is significantly worsened. In both cases, the effectiveness of detoxification is reduced.

The method is as follows: a peritoneal dialysis catheter is inserted into the abdominal cavity of a patient with hepatic insufficiency, and then a solution is used to treat renal failure, to which albumin is added until a concentration of 30-40 g / l is reached. Within 2-4 hours, the solution is left in the abdominal cavity, at this time toxic substances move from the body into the dialysis solution. After that, a dialysis solution containing albumin saturated with toxins is poured into a plastic container, from where it is pumped at a speed of about 20-30 ml / min into an artificial kidney dialyzer, where it is purified from water-soluble toxic substances, then it is passed through activated carbon and anion-exchange resin. Here, toxins associated with albumin are absorbed. Then the purified solution again enters the abdominal cavity. The cycle is repeated many times during the day, after which the albumin solution, artificial kidney dialyzer, sorbent and anion exchange resin are replaced.

The proposed method has passed clinical trials in the transplantation department of the Russian Scientific Center of Medical Sciences.

Example 1 To a patient weighing 72 kg, a peritoneal Tenkoff catheter was implanted in the abdominal cavity under local anesthesia. The level of total bilirubin before dialysis was 596 μmol / L, direct - 302 μmol / L, blood albumin - 31 g / L. 1500 ml of a Frezenius DPCA 2 solution was introduced into the abdominal cavity, into which 650 ml of 10% albumin was added, resulting in an albumin concentration of 30 g / l. After 2 hours, 2300 ml of dialysis solution was discharged with an albumin concentration of 32 g / l, total bilirubin - 188 μmol / l and direct - 88 μmol / l. The concentration of these substances in the blood was equal to: albumin - 34 g / l, total bilirubin - 566 μmol / l and direct - 290 μmol / l.

Then, 1500 ml of the same solution was added with the addition of 1000 ml of 10% albumin (40 g / l). Exposition - 4 hours. 2600 ml of a dialysis solution with an albumin concentration of 34 g / L, total bilirubin - 205 μmol / L and direct - 102 μmol / L were drained. At the same time, in the blood, the concentration of total bilirubin was set equal to 512 μmol / L and direct - 273 μmol / L.

Thus, in 2 hours, using a solution containing 30 g / l of albumin, 432 μmol of total and 202 μmol of direct bilirubin were removed from the patient's body. The concentration of total bilirubin in the blood decreased by 5%, direct by 4%. And in 4 hours with a solution containing 40 g / l of albumin, 533 μmol of total and 265 μmol of direct bilirubin were removed from the patient's body. The concentration of total bilirubin in the blood decreased by 9%, direct - by 6%.

Albumin regeneration was carried out by perfusion through an artificial kidney dialyzer, through a sorbent and anion exchange resin at a rate of 25 ml / min. The bilirubin content at the outlet of the regeneration system decreased by 84%. The patient's condition remained stable, his condition was satisfactory.

Findings:

- During the study, the level of bilirubin in the patient's body decreased by 14%. At the same time, for 2 hours when using an albumin concentration of 30 g / l, the decrease was 5%, and for 4 hours with a concentration of 40 g / l - 9%.

- With an increase in albumin concentration from 30 to 40 g / l and exposure of the solution in the abdominal cavity from 2 to 4 hours, the amount of bilirubin removed increased from 432 to 533 μmol.

Conclusion The proposed method for the treatment of liver failure allows us to achieve the goal of increasing the effectiveness of detoxification, and ensures the safety of the patient due to the lack of extracorporeal blood circulation.

Claims (1)

A method of treating liver failure, including the use of an albumin solution as a dialysis fluid, followed by purification through an "Artificial Kidney" apparatus, a carbon sorbent, anion exchange resin and repeated detoxification cycles using albumin and its subsequent deligandization, characterized in that the removal of albumin-bound toxins from the patient’s body is produced through the peritoneum by introducing through a catheter into the abdominal cavity a solution containing albumin at a concentration of 30-40 g / l, with its exposure for 2 to 4 hours and subsequent removal from the abdominal cavity, and the perfusion rate of the albumin solution during its cleaning is 20-30 ml / min.