Extracorporeal detoxification is a method of treating blood by filtering through membranes through centrifugation, irradiation, cleaning with sorbents outside the bloodstream. It is carried out in order to remove components that provoke or support the course of a particular disease. In this case, medications are added to the blood to change its fluidity. This therapy technique is used in various medical fields, but most often in toxicology and rheumatology.
The correct choice of detoxification method, which is determined by specialists and depends on the physicochemical properties of the toxin, plays an important role in the positive result of treatment.
Purposes of the event
The main goals of extracorporeal detoxification are:
- improvement of electrolytes, water and gases inblood, metabolic processes, enzyme, hormonal and cellular composition;
- removal of metabolic products;
- eliminate various toxic compounds;
- reducing cholesterol levels with its excess;
- removal of abnormal proteins and triglycerides from the blood, as well as circulating immune complexes, antigens, antibodies (including those working against one's own tissues);
- eliminate inflammatory stimulants.
Blood purification using modern equipment allows you to selectively remove unnecessary components that provoke the development of pathological conditions in the body. In addition, this procedure allows you to enter into the blood pharmacological drugs for the treatment of certain diseases. Thanks to such procedures, anti-allergic, anti-inflammatory, immunomodulatory and detoxification effects are achieved.
Extracorporeal detoxification methods help reduce the severity of the pathological process, prevent complications, and reduce the likelihood of death. The procedure also prevents the transition of the patient's acute condition into a chronic form, helps to reduce the need for medications and prolonged stay in a hospital, restores lost working capacity and improves the quality of life of patients.
Extracorporeal detoxification techniques are very common in emergency abdominal surgery.
This procedure can bebe used as the main method of therapy or included in the combined treatment. Before her appointment, a complete examination of the body is carried out, the determination of the Rh factor, blood group and indicators of its composition. A coagulogram and a study for bacterial and viral infections are also prescribed.
When is extracorporeal detoxification indicated in surgery?
Indications for conduction
A specialist can prescribe a procedure for intensive care of the following pathologies:
- antiphospholipid syndrome;
- rheumatological systemic diseases: vasculitis, arthritis, granulomatosis, lupus erythematosus, scleroderma, dermatomyositis;
- in case of poisoning with medicines, chemical compounds in production;
- poisoning with alcohol, drugs;
- after environmental disasters;
- radiation damage to the body;
- toxicosis in pregnant women;
- Rhesus conflict;
- genitourinary infections;
- glomerulonephritis;
- insufficient cleansing function of the liver or kidneys;
- diabetes;
- autoimmune thyroiditis;
- thyrotoxicosis;
- skin diseases: psoriasis, eczematous process, neurodermatitis, furunculosis;
- myasthenia gravis;
- polyneuropathy or polyneuritis;
- Parkinson's disease;
- multiple sclerosis;
- cirrhosis of the liver;
- pancreatitis with areas of necrosis in the pancreas;
- violation of the intestinal microflora;
- focal inflammation orsuppuration in the lungs;
- atherosclerosis;
- bronchial asthma;
- myocardial ischemia;
- high blood pressure;
- hypertension.
Extracorporeal detoxification methods in intensive care are used urgently, without diagnostic procedures, in acute emergency conditions, such as sepsis. In emergency abdominal surgery, the procedure may be performed for conditions such as ruptured appendicitis, peritonitis, acute liver and pancreatic disease.
In addition, the use of extracorporeal detoxification methods in surgical dentistry is known: for abscesses of soft tissues of the oral cavity, jaw bones, etc.
Contraindications to the procedure
The main contraindications for extracorporeal detoxification are:
- the presence of bleeding, malignant processes in the body, as well as terminal (irreversible) conditions or complete decompensation of the circulatory system;
- allergy to plasma and its components, as well as to substances that reduce coagulation ability;
- infections or foci of suppuration in an acute form;
- pronounced arterial hypotension;
- tachycardia, shock or collapse;
- low volume of circulating blood;
- phlebitis.
During pregnancy, the body cleansing procedure can be carried out only in severe conditions, strictly for medical reasons, taking into accountrisk-benefit ratio.
Ways
The most common methods of extracorporeal detoxification in the complex therapy of critical conditions are lymphocytopheresis, plasmapheresis, hemosorption, cryoapheresis, photopheresis, cascade filtration.
With discrete plasmapheresis, blood is taken from a patient (up to 0.8 l), placed in a special container, and then transferred to an apparatus in which it is separated by centrifugation into plasma and cells. Plasma is removed along with immune complexes, autoantibodies, metabolic products, toxic compounds, inflammatory agents. Instead of plasma, s alt solutions, protein and colloidal components, donor plasma are added to blood cells.
Membrane plasmapheresis
In membrane plasmapheresis for extracorporeal detoxification, two catheters are inserted into the venous system. Blood is taken from the first one, passed through the filtration membrane and injected back through the second catheter. This method allows you to separate the plasma, and the blood cells are returned to the body. The liquid portion is freed from toxins, allergic, inflammatory and autoimmune substances. Medicines can be injected into it, it is irradiated with laser light, ultraviolet, ozonized.
Lymphocytopheresis
Lymphocytopheresis removes lymphocytes from the blood. This method is used for violations of the immune system,excessive production of cells that destroy the body's own tissues during an inflammatory process of an autoimmune nature. It is indicated for pathologies of connective tissue. The procedure can be combined with cell activation by cytokines and blood irradiation.
Hemosorption
During hemosorption, venous blood enters the adsorbents, then is introduced back into the body. It is used in infectious and allergic processes, autoimmune pathologies (collagenosis). May be accompanied by low blood pressure, damage to blood cells and muscle tremors.
Photopheresis
In photopheresis, the patient takes drugs that increase the sensitivity to light, and then outside the body, the blood is irradiated with long-wave ultraviolet rays and returned to the body. It is used for diseases of the connective tissue, skin, psoriasis and fungal infections. Blood can be centrifuged and then irradiated, or these procedures are carried out on the machines at the same time.
Immunosorption
When immunosorption is carried out selective purification of blood from specific proteins - antigens, toxins, antibodies, and its main components remain unchanged. This procedure is carried out for poisoning, kidney disease, allergies, autoimmune pathologies. The disadvantages of this technique are the limited number of sorbents and the rather high price.
Cryoapheresis is similar to plasmapheresis, only the plasma is frozen and heparinized, and the cryoprecipitate is removed. It is used for atherosclerosis, eczema, gout, autoimmunevasculitis.
When is a procedure not scheduled?
Absolute contraindications to the above procedures are:
- bleeding;
- severe brain disease;
- heart failure at the stage of decompensation;
- oncological pathologies with metastases;
- Neuro-psychiatric diseases.
The list of relative restrictions includes:
- blood clotting disorders;
- arrhythmia;
- hypotension;
- decrease in plasma protein;
- ulcerative lesion of the digestive tract;
- infectious diseases;
- menstruation.
