Plasmapheresis - ndichiyani? Plasmapheresis: phindu ndi mavuto, contraindications, mitengo ndi njira. achire plasmapheresis

Zipatala zambiri masiku ano khumi zapitazi, anayamba kupereka ndondomeko okwera mtengo - plasmapheresis. Kodi izo, ndipo kodi matenda imasonyezedwa? Kaya njira imeneyi ndi woopsa ndipo mmene anakhala? Pano pali mfundo zikuluzikulu zimene zimachitika odwala pamene iwo amalangiza njira nzeru kutisambitsa magazi kuchokera "slags".

plasmapheresis ndi chiyani?

Izi njira zamakono yoyeretsera thupi pa mlingo ma imathandiza magazi pogwiritsa ntchito zipangizo zapadera. Chinali cholinga zochizira matenda ambiri ndipo chipulumutso chokha kwa ena kwambiri matenda osowa. Mawu akuti "plasmapheresis" tichipeza mawu awiri - ". Plasma kuchotsa" "plasmas" ndi "apheresis" kuti Latin akhoza kwenikweni ndimene

Ndondomeko zinachitikadi mu zipatala anthu, zipatala payekha ndi ngakhale nthawi zina kunyumba. Plasmapheresis magazi movutikira kuzindikira kumapeto kwa zaka za m'ma otsiriza, koma kale anatha kupulumutsa masauzande thanzi anthu.

History of njira chiyambi

njira imeneyi kunayamba ntchito ya magazi Kulola monga mankhwala a matenda aliwonse. Kwa nthawi yaitali, ichi "woipitsitsawu" njira ya mankhwala ali wawaiwala madokotala, koma pofika m'ma XX atumwi, akatswiri ayamba kuyesa kulenga chipangizo cha kulekanitsa magazi mu magawo ndi kuchotsa mbali madzi kubala zotsatira achire.

Kale mu zaka 70-80 ya plasmapheresis lakhala likugwiritsidwa ntchito mwakhama US ndi zinatchuka mu USSR. Koma conclusiveness mtima kwa njira alibe koma mkulu zokwanira, chifukwa mayesero matenda amafuna zaka zambiri ntchito. Komabe, asayansi si ntchito ndipo anapitiriza kuphunzira plasmapheresis. Kodi uja kwa anthu? Asayansi khama anapereka mankhwala njira yangwiro ndi zothandiza kuyeretsa magazi. Panopa kuchotsa "zakhudzana" plasma imatengedwa njira kwambiri mu maiko ambiri pathological amene anatsagana ndi intoxications zosiyanasiyana chamoyo.

Kodi ndi mitundu iti ndi njira kulibe plasmapheresis

Pali classifications zitatu zikuluzikulu zomwe plasmapheresis.

1. Mwa Kusankhidwa

Ngati kuyeretsedwa magazi ndi achire mu chikhalidwe ndi ntchito kuchotsa matenda kapena chikhalidwe, ndi - achire plasmapheresis. Choncho osasankhidwa mphako zinthu adzabwezedwa kwa wodwala, ndi madzi a m'magazi a m'malo mwa magazi mwiniwake kapena njira yapadera.

Ngati kulekana kwa magazi wochititsidwa kupeza madzi kuchokera munthu wathanzi ntchito zina, monga ndondomeko ya amatchedwa plasmapheresis mwiniwake.

2. Mogwiritsa ntchito

Pali plasmapheresis apawokha ndi zodziwikiratu. Mbali yoyamba wodwala wadzipangira yambiri magazi aikidwa mu chidebe wosabala ndi mchere; kutetezera ndi khalidwe plasma kulekana ndi centrifugation kapena mpweya. Ndiye wodwalayo jekeseni kudzera m'mitsempha otsalira pambuyo kuchotsa khungu Unyinji wa madzi, kuchepetsedwa ndi saline. njira umenewu umatchedwanso bukhuli.

Ndi zodziwikiratu plasmapheresis zosonkhanitsira magazi, kusefera ndi kubwerera ku chidebe unachitikira ku mbali yaing'ono mwa chipangizo kulekana. Komanso njira zonse mosalekeza. Njira imeneyi ndi bwino kwambiri wodwalayo zambiri mafoni ndiponso kupewa kuwonongeka kwa maselo, monga kuyenera bukhuli.

3. Ndi njira kuchotsa ndi processing plasma

Malinga ndi njira imene gawo madzi chikutha plasmapheresis lagawidwa:

• The centrifuge.
• Kakhungu.
• Yamazinga.
• Sedimentation (bezapparatny plasmapheresis).
• Krioplazmaferez.

Njira iliyonse ali ubwino wake ndi kuipa. Wotchuka kwambiri imatengedwa kuti Kakhungu plasmapheresis. Sedimentation njira pafupifupi si ntchito, koma mtengo kwambiri kuposa ena.

Kufotokozera za njira

njira centrifuge zachokera malamulo yokoka. chipangizo amapereka magazi atembenuza pa liwilo, kotero kuti analekana mu ting'onoting'ono. zinthu Choncho mphako adzabwezedwa kwa thupi, ndi madzi a m'magazi kuchotsedwa. Njira imeneyi ndi achikale, ali ambiri contraindications Komanso nthawi zambiri zidzachitika choipa centrifugation selo.

Kakhungu njira zimaphatikizapo kugwiritsa ntchito zida za zida ndi Zosefera wapadera ndi pores amene amalola plasma, zinthu zinapangidwa yomweyo. Njira imeneyi ubwino wake:

• Sterility plasmafilters.
• Chitetezo matenda.
• The mofulumira njira.
• Ochepa contraindications.
• maselo si kuonongeka.
• N'zotheka ntchito ndondomeko zochizira odwala khansa.

njira yamazinga amakhala mu magazi akudutsa processing awiri. Choyamba, misa selo ndi wosiyana ndi madzi a m'magazi a amalisefa poyeretsa mamolekyulu lalikulu, mapuloteni ndi lipids. Njira imeneyi ndi otchuka pa matenda a atherosclerosis.

Bezapparatny plasmapheresis (kapena sedimentation) ikuchitika popanda kugwiritsa ntchito zipangizo zapadera. Magaziwo anapatukana mu magawo awiri mchikakamizo yokoka. Izi ndi plasmapheresis lophweka ndi yotchipa. mtengo wake ndi zimasiyana mtengo wa njira zina. Koma salola pokonza mabuku yaikulu ya magazi.

Krioplazmaferez ikukhudza kuchotsa madzi kuchokera mazira ake pa -30 ^{° C,} kenako n'kumawotha 4 ^{° C} akutsatiridwa ndi centrifugation. Part wa madzi amene woterowu linamasuka, ndi madzi a m'magazi yotsalayo ndi anabwereranso mu mtima.

Mmene thupi wochita

plasmapheresis ndondomeko zimathandiza kuchotsa thupi la mankhwala yotsalira ya kagayidwe (urea, creatinine, asidi uric), chitetezo, antigens, mahomoni, macromolecular zamadzimadzi amkhalapakati a kutupa ndi zinthu zina zoipa. Kuchotsa madzi yokumba amachititsa hypovolemia kuti amakwiya ndi compensatory ndi kulolerana wa onse chitetezo cha mthupi. Komanso, madzimadzi iri yofulumira ku zimakhala mu zotengera kuti abwezeretse kufalitsidwa magazi buku. Zimenezi zimabweretsa kuchepa kutupa ndi amachepetsa zotsatira poizoni wa zoipitsa maola angapo.

Komabe, tsiku lina kuchuluka kwa poizoni mu magazi wabwezeretsedwa kachiwiri. Choncho, akatswiri amalangiza plasmapheresis Inde, cholinga cha maulendo 3-4. Ndi mulingo uliwose motsatizana ndondomeko yatsopano ndi kutsukidwa, nsupa choyamba, ndiye nsalu, ndiyeno selo. The katundu rheological magazi wasinthika m'njira zabwino, kuchotsa kukhuthala kwambiri, kuchuluka magazi ndi otaya mpweya ziwalo ndipo zimakhala. Izi zipangitsa kusintha mkhalidwe ambiri a chamoyo uzigwira dziphunzitsiranso, komanso amachotsa zoipa zizindikiro mankhwala kuledzera.

Komabe, chodalira nzeru kuwombola madzi a m'magazi Sikuti, chifukwa nthawi zonse zofunika kuti achite chithandizo mabuku a matenda aliwonse, kutsatira malamulo dokotala.

Kuti aonetse njirayi

Tsopano, madokotala ambiri mankhwala plasmapheresis. Kodi njirayi - odwala ambiri sadziwa n'komwe. Ndipo komabe, kudziwa kodi Nzofunikira kugwirizana pa njira wa chithandizocho anafunikiradi. Plasmapheresis - kuyeretsedwa kwa thupi, amene analimbikitsa zochizira pafupifupi onse ziwalo ndi kachitidwe. Komabe, pali zingapo pathologies imene plazmoobmenom mankhwala kumasonyeza mtheradi. Izi zikutanthauza kuti kulephera kwa ndondomeko kungachititse kuti imfa ya wodwala. matenda monga:

• zenga magazi m'thupi khungu ;
• thrombocytosis ndi leukocytosis;
• erythroleukemia;
• porphyrin matenda;
• hypercholesterolemia (kumtundu);
• matenda Rufu ndi;
• DIC;
• hyperviscous syndrome;
• myasthenia gravis;
• Guillain-Barre syndrome;
• anachedwa thrombocytopenia;
• mioglobinemiya;
• intravascular hemolysis;
• syndrome Goodpasture ndi ;
• syndrome Gasser ndi;
• thrombotic thrombocytopenic purpura;
• cryoglobulinemia;
• aakulu polyneuropathy;
• ziphe poizoni.

Wachibale zikuonetsa kuti plasmapheresis ndi:

• Kudwala pa mundawo m'mimba: anam'peza matenda a m'matumbo, matenda amene amatupitsa.
• matenda a mtima: chikhalidwe pambuyo vuto la mtima, myocarditis, la misempha ndi zina zotero.
• Ziwengo: atopic deramatit, pollinosis ndi ena.
• matenda Dermatological: psoriasis, pemphigus, nsungu, etc.
• matenda aimpso: Glomerulonephritis, mkodzo thirakiti matenda, ndi zina zotero.
• Matenda a dongosolo kupuma: mphumu, hemosiderosis.
• vuto la chiwindi: autoimmune chiwindi ndi ena.
• zosokonezeka Septic pambuyo opaleshoni.
• Zokhudza zonse vasculitis.
• zotupa poizoni Oncology.
• Atherosclerosis.

Posachedwapa, gynecologists kulangiza ndalama plasmapheresis pa mimba ngati mkazi ali ndi matenda toxicosis, pali Rhesus-nkhondo kapena fetoplacental insufficiency. mndandanda Ichi ndi chachitali kwambiri. Ndipotu, pali 200 matenda amene akhoza bwinobwino ntchito plasmapheresis. Contraindications njira imeneyi komanso zilipo.

Amene kusiya njira ngati

Kwa njirayi, pali contraindications ambiri. Koma koletsedwa kuchita pamaso pa zotupa sizingasinthe ziwalo, saletsa magazi, coagulation chisokonezo ndi chapamimba chilonda.

Osavomerezeka magazi kuyeretsa kuphwanya mungoli ndi kugunda kwa mtima, kuthamanga kukakhala, kuchepetsa kukhuthala kwa magazi kusamba, matenda pachimake matenda, hypoproteinemia, magazi m'thupi odwala achikulire osiyanasiyana mantha, matenda aakulu chiwindi, "oipa" mitsempha.

Izo zinkakhala kuti plasmapheresis pa mimba ndi zovulaza thanzi la mwanayo, koma kafukufuku posachedwapa zikutsimikizira ayi. Mwachibadwa, phunziro la ndondomeko mosamalitsa pa umboni ndi mogwirizana ndi malangizo.

Choncho, ena a boma akuletsa kugwiritsa ntchito plasmapheresis ngati njira mankhwala. Contraindications ayenera ayesedwa ndi dokotala nawo, makamaka ngati pali chiopsezo cha kuwonongeka kwa thanzi wodwala ngati kulephera kwa ndondomeko.

Kodi chithandizocho

Pakuti plasmapheresis sikutanthauza maphunziro apadera. Kawirikawiri ndondomeko ikuchitika mu maudindo wapadera mpheto kapena mwachindunji mu chipinda cha wodwalayo. Kuti tichite zimenezi, wodwala amagona pa bedi wapadera ndipo akutenga malo omasuka. Malinga njira, ndi catheter wapadera (fleksulyu) kutumikiridwa mu dzanja limodzi kapena awiri. Nthawi zambiri zimenezi pogwiritsa ntchito mtsempha mu unakhota wa chigongono. Ngati wodwala mu chikhalidwe aakulu, catheter aikidwa mu mtsempha subclavian. Magazi si aumirira ndi thrombus kupangidwa, kuwonjezera fleksulyu kutumikiridwa heparin.

ndondomeko kumatenga za 1-2 maola. Izo zimatengera njira ndi kuchuluka kwa magazi kulitsuka. Pa mwai onse wodwala nthawi moyang'aniridwa ndi achipatala. Iye anayeza umagunda mofulumira, kuthamanga kwa magazi, kupuma ndipo adafikapo kwa kotunga mpweya zimakhala ndi.

Apparatuses kwa plasmapheresis ndi kunyamula kapena n'kupuma. Woyamba ndi zambiri yabwino chifukwa kusamutsidwa kulikonse kuchipatala kapena kunyumba wodwalayo. chipangizo amatenga magazi portionwise ndi 40 ml ya nthawi, aisadza iwo umabwereranso kudzera catheter ndi kachiwiri amatenga magazi. Ena zipangizo ntchito yoyendetsa basi wa anticoagulants. Mu mphindi imodzi, plasmapheresis zida akhoza pokonza za 100 ml magazi, mwachitsanzo. E. Per ola angachotse bwanji 800 ml ya madzimadzi owonjezera.

Akatswiri amalangiza kuchotsa gawo limodzi zosakwana kotala ya madzi kufalitsidwa. Madokotala kuyembekezera chithunzi ichi malingana ndi munthu: kulemera ndi buku magazi (CBV).

Amadziwika kuti plasma 55% ya Bcc. Ndipo kuti aone yotsirizira chithunzi, m'pofunika kuchulukitsa ndi thupi ndi 75. Mwachitsanzo, munthu akulemera makilogalamu 80 Umodzi mukufuna kuchotsa nambala zotsatirazi plasma:

80 × 75 × 825 ml ya = 0,55h0,25.

Nkofunika mogwirizana ndi kufanana onse, kuchititsa plasmapheresis. Phindu ndi mopweteka njira achire zimadalira zinthu zambiri, kuphatikizapo yolondola kuwerengetsera lapansi.

Kodi plasmapheresis wavulala?

Posachedwapa, njirayi mtengo ali pabwino monga limathetseratu vuto lina lililonse chifukwa mavuto onse. zipatala Private makamaka mwakhama kulimbikitsa plasmapheresis. Phindu ndi mopweteka njira mwachindunji amadalira Luso la madokotala. Koma monga njira ina iliyonse mankhwala oyenera, ali zotsatira zake zam'mbali ndi kuipa:

• Anaphylactic mantha.
• Ziwengo kuti plasma woperekayo ndi kuchotsa ndi madzi.
• matenda Autoimmune impso monga anachita kwa plasma mwiniwake.
• Infection kuchokera m'madzi mwiniwake.
• Kukula kwa sepsis zotsatirazi standardization wa aseptic.
• Magazi (ngati pali mavuto ndi clotting).
• Thrombosis (opanda ntchito anticoagulants).
• kusiya magazi.
• Kuchotsa osati poizoni komanso zakudya pamodzi ndi madzi a m'magazi a.
• Akusunsa chitetezo chokwanira.
• Kagayidwe kachakudya chisokonezo ndi chiwerengero cha mankhwala m'magazi.
• Nseru.
• Mutu.

Izi ndi lalikulu kwambiri ndi zovuta ndondomeko, kotero muyenera kusamala posankha malo chithandizo. Zipatala zambiri payekha kupereka odwala plasmapheresis. Kodi mtundu wa mabungwe omwe akatswiri ntchito, kaya wa kusamvana ndi ndondomeko? Onse ayenera kudziwa pamaso povomera chithandizo, kuti kugwa m'manja a zoberana osaphunzira. Pajatu kungachititse kuti zoopsa zotsatira zake.

Zotsatira Kodi tingayembekezere

Mphamvu ya plasmapheresis anatsimikizira mu nkhani ya matenda ambiri. Zonse atathana zabwino zotsatira ndondomeko ngakhale pamene zizindikiro wachibale. Komabe, ayenera kumvetsa kuti monotherapy kuti si nthawi zonse kuthandiza. Choncho, n'kofunika kutenga mankhwala mabuku odziwa oyenerera, popanda kudalira machiritso njira imodzi kuchotsa madzi.

Kuti iyende bwino, muyenera onetsetsani kuti khalidwe la chisamaliro ndi kubatizidwa kudzifufuza kuyambirira kutsimikiza pakalibe contraindications kugwiritsa ntchito maluso amenewa achire monga plasmapheresis.

Mtengo wa njirayi si mkulu (4500-5500 ths. Rubles), ndipo wodwalayo adzafunika magawo oposa mmodzi kapena awiri, ndipo 3-4, mwinamwake chithandizo sadzakhala tanthauzo lenileni. Izi tiyenera kuziganizira. Komabe, zipatala zambiri mumachotsera ngati nthawi kumene ndi magawo oposa 5. Tikumbukenso kuti njirayi sangakhale wotchipa, T. Kwa. The zida ndi zipangizo tsopano mtengo ndithu. Choncho sakhulupirira chipatala kumene ndondomeko amachitidwa pa mtengo wotsika kwambiri.

kuti adzimvera

Inde, mankhwala ukuwawa mthumba wodwalayo, koma zedi. Kupititsa patsogolo mu chikhalidwe ambiri, kulolerana ntchito zoteteza ndi compensatory, normalization wa magawo rheological magazi, kuchotsa zizindikiro za kuledzera - uwu si mndandanda wonse amene amadza zabwino tiganizire ndondomeko pa thupi.

Plasmapheresis ndi njira yatsopano yomwe imathandiza odwala ambiri kuthana ndi matenda awo ndi kuyeretsa magazi a plasma "owonongeka". Njirayi ikuwonetsedwa ndi nthendayi yambiri ndipo ili ndi zochepa zotsutsana. Kukhazikitsidwa kwa plasmapheresis mothandizidwa ndi akatswiri oyenerera komanso kusunga malangizo onse kumapangitsa kuti pakhale njira zabwino zothandizira ngakhale matenda omwe sapezeka.