He althcare institutions around the world spend a lot of money on blood transfusions. Therefore, countries with advanced medicine are busy developing artificial blood substitutes. They do not perform the full function of blood, because they do not contain formed elements. Therefore, transfusion media used to normalize blood function are more correctly called plasma-substituting solutions. There are several thousand drugs, and they are widely used in various pathological conditions.
Infusion-transfusion therapy
The method of treatment in which the volume and composition of blood, tissue fluid and intracellular fluid is corrected by parenteral (usually intravenous) administration of biological fluids is called infusion-transfusion therapy.
Under infusion treatment is understood as intravenous administration of plasma-substituting solutions, under transfusion therapy - blood transfusion, itsingredients and drugs. Blood replacement drugs are used only under the strict supervision of a physician.
What is the therapy for?
Infusion-transfusion therapy has a variety of effects. It is carried out only through disposable systems for transfusion of infusion solutions. Medicinal liquids that are in a plastic bag flow out faster than from glass bottles. Pace can be controlled using computer controlled infusion pumps.
Therapy Goals:
- Elimination of hypovolemia.
- Introduction of cellular components of blood (leukocytes, platelets, erythrocytes) in case of their deficiency.
- Elimination of water-electrolyte and KS imbalance.
- Normalization of the chemical composition of the blood with a deficiency of plasma coagulation factors or platelets.
- Intravenous infusion of nutrients bypassing utilities.
- Elimination of violations of the rheological properties of blood.
- Elimination of coagulation disorders.
- Treatment of immunodeficiency conditions.
- Elimination of metabolic and microcirculation disorders.
- Treatment of intoxication.
Depending on the composition of the therapeutic properties, infusion solutions are divided into blood, its components and preparations, plasma-substituting agents. The latter have a long shelf life and are unpretentious in transportation.
What are plasma replacement solutions?
The volume of circulating blood can only be replenished with blood components. Plasma substitutessolutions - medicines similar in composition to blood, used with a deficiency of the components of its liquid part. Means that are administered in large doses are called infusions. To date, disposable polymer systems for blood transfusion of the PK-11-01, PK-22-02, PR-11-03 types are used.
Plasma substitutes are widely used to normalize the quantitative indicators of homeostasis in various pathological conditions. Solutions are used for extrarenal blood purification, organ transplantation, isolated regional perfusion. Controlled artificial hemodilution (blood dilution) is carried out using plasma substitutes.
Solutions are mainly used to treat and prevent shock of various etiologies, normalize blood pressure, improve hemodynamic parameters. Plasma substitutes are used for blood loss, severe burns, for the prevention of thromboembolism after surgery, and for various intoxications. The funds are highly effective, they are poured without regard to group affiliation.
Classification of plasma substitution solutions
According to the functional properties and direction of the therapeutic action, the agents are divided into several groups.
- Hemodynamic solutions are preparations made on the basis of natural or synthesized colloids. They are used for anti-shock therapy, recovery of hemodynamic disorders.
- Detoxification solutions are low molecular weight dextrans that can remove toxins from the body.
- Saline solutions andosmodiuretics correct the chemical composition of the blood in dehydration caused by cerebral edema, increased renal hemodynamics, diarrhea.
- Parenteral nutrition products provide intravenous delivery of nutrients.
- Oxygen carriers contribute to the restoration of the respiratory function of the blood.
- Complex solutions - biodegradable broad-spectrum products.
Hemodynamic solutions
Hemodenamic drugs correct the central and peripheral blood flow through the vessels. They circulate in the bloodstream for a long time, maintaining normal blood pressure. There are three groups of hemodynamic plasma-substituting solutions: hydroxyethyl starch preparations, gelatin, dextran derivatives.
Dextrans are polysaccharides produced by the bacterium Leuconostok mesenteroides. Drugs:
- Polyglukin.
- Macrodex.
- Neorondex.
- Intradex.
- Reopoliglyukin.
- Lomodex.
- "Dextran 40".
Hydroxyethyl starch preparations are infusion agents based on hydroxyethyl starch.
- Volekam.
- Plasmasteril.
- Refortan.
- "Stabizol".
- Plasmotonin.
Gelatin preparations are colloidal solutions based on denatured gelatin protein. The most common are: Gelatinol, Gelofuzin, Physiogel, Plasmogel, Zhelofusin.
Detoxification drugs
Infusion solutions of detoxification action are used for artificial detoxification. The products are made on the basis of a polymer formed from N-vinylpyrrolidone, which is highly soluble in water. The drugs have an anti-aggregation effect, bind toxins circulating in the blood and remove them from the body.
Indications for the use of drugs are: intoxication of various genesis, radiation sickness, acute dysentery, leukemia, burn disease, sepsis. Essential drugs:
- "Hemodez-N". Due to the high likelihood of side effects in recent years, the remedy is trying to find a replacement.
- Polydez.
- Enterodesis.
- "Neohemodes".
- Neocompensated.
Regulators of water-electrolyte balance and acid-base balance
These drugs include saline and electrolyte solutions. They are able to quickly and effectively replenish the deficiency of interstitial fluid, restore the osmotic pressure of the plasma, increase the body's water resources, and correct the water-s alt metabolism.
When conducting therapy, it is necessary to take into account the electrolyte composition of plasma substitutes, the mechanism of action, and kinetics. The main component of crystalloid preparations is sodium. It is the main electrolyte, 80% of it is outside the vascular bed in the fluid of the extracellular space, so the sodium solution introduced into the blood quickly turns out to be outside the vessels.
Infusions of solutions with acidic properties, even at high doses, do not disturb the acid-base state, but with developed metabolic alkalosis, transfusion of plasma containing bicarbonate or excess sodium can increase the ratio of concentrations of hydrogen and hydroxyl groups. The most commonly used drugs are:
- Saline sodium chloride solution 9%.
- Ringer-Locke solution.
- Bieffe sodium lactate solution.
- "Disol", "Atsesol", "Kvartasol", "Trisol.
- Lactasol.
- Sanasol.
Means for parenteral nutrition
Drugs are used when it is impossible to feed patients through the mouth due to various pathologies, injuries, and surgical operations. For therapy, a protein blood-substituting fluid, fat emulsions and carbohydrates are used.
Protein preparations are the basis of parenteral nutrition. Protein hydrolysates and mixtures of amino acids are isolated. The composition of the preparations must necessarily include 8 essential amino acids, if at least one of them is missing, then protein synthesis will be disturbed. Preparations for intravenous protein nutrition:
- "Hydrolysin".
- Cosein Hydrolyzate.
- "Aminosteril".
- "Aminotroph".
- Infusamine.
- Vamin.
- Polyamine.
- Vaminolact.
- Neframin.
- "Fibrinosol".
The use of fat emulsions allows a large amount of calories to be injected into a small amount of liquid. With the help of fattyemulsions, the synthesis of phospholipids is carried out, which is important in protein and lipid metabolism. Depending on the composition, 3 generations of emulsions are distinguished:
- I generation (long chain): Intralipid, Lipofundin S, Lipovenosis, Lipozan.
- II generation (medium chain triglycerides): Liquidgen, Medialipid.
- III generation (emulsions with a predominance of omega-3 fatty acids): Structolipid, LipoPlus, Omegaven. Carbohydrates are used to meet energy needs. The most common solutions in medical practice are glucose, fructose, Sorbitol, Xyliton.
Oxygen carriers
Oxygen transport is one of the important functions of the blood. Oxygen-carrying preparations help to improve its rheological properties, reduce viscosity, and increase fluidity. While most of the funds are under development, but side effects have already been identified. The respiratory system responds well to plasma substitutes administered through the system for transfusion of infusion solutions. Therefore, prolonged administration of oxygen carrier drugs can lead to the destruction of capillaries in the lungs. Drugs are divided into two groups:
- Synthetic perfluoroorganic compounds: Perftoran, Perfucol.
- Modified oxygen-carrying proteins: Gelenpol, hemoglobin solutions.
Polyfunctional drugs
Complex plasma-substituting solutions are preparations that can simultaneously provide several effects. Basically they havehemodynamic, detoxifying, rheological properties. The most common complex blood substitutes: Reogluman, Polyfer, Rondferrin.
Conclusion
The development of blood substitutes is carried out in order to reduce the use of donated blood. In addition, most patients requiring a transfusion do not need all of the components found in a whole body fluid. The use of donated blood is dangerous for patients with renal and heart failure. Unlike plasma-substituting solutions, blood can be transfused without fail, taking into account the group affiliation. For storage and transportation, special conditions are needed, for the creation of which large amounts of money are spent. It is worth noting that it is not possible to completely refuse blood in favor of plasma-substituting drugs.
