Plasmapheresis - kuyini? Plasmapheresis: inzuzo kanye nokulimala, Izimo, amanani kanye nezindlela. plasmapheresis zokwelapha

Imitholampilo eminingi yesimanje kule minyaka eyishumi eyedlule, waqala ukunikela inqubo eqolo - plasmapheresis. Kuyini, futhi ngaphansi kwaziphi izifo sikhonjiswa? Kungakhathaliseki ukuthi le ndlela kuyingozi futhi kanjani it wachitha? Nazi izindaba main eziphakamayo iziguli uma abazincomayo indlela innovative ukuze ahlanze igazi "slags".

Kuyini plasmapheresis?

Le ndlela yesimanje okuhlanza umzimba emangqamuzaneni okufika igazi usebenzisa amadivaysi ezikhethekile. Kuhloswe for ekwelapheni izifo eziningi futhi insindiso kuphela kwabanye kakhulu izifo ezingavamile. Igama elithi "plasmapheresis" linamagama ezimbili - ". Plasma ukususwa" "akhishwe ububomvu" futhi "apheresis" ukuthi Latin kungenziwa ngokwezwi nezwi ehunyushwa ngokuthi njengoba

Inqubo kwenziwa ezibhedlela zomphakathi, emitholampilo yangasese ngisho ngezinye izikhathi ekhaya. Plasmapheresis igazi wathola ukuqashelwa ekupheleni kwekhulu leminyaka elidlule, kodwa kakade wakwazi ukulondoloza amakhulu ezinkulungwane impilo zabantu.

Umlando Lokudabuka indlela

Lokhu ihlehlela emuva kokusebenzisa igazi-angakuvumela njengendlela ekwelapheni isifo yimuphi. Kwaphela isikhathi eside, ngale ndlela "ngesihluku" yokwelapha sekulibalekile odokotela, kodwa phakathi nawo XX leminyaka, izazi nabanye abantu baye baqala ukuzama ukudala kudivayisi ekwehlukaniseni igazi ngezigaba kanye nokususwa ingxenye yayo liquid ukukhiqiza nomphumela oqabulayo.

Kakade iminyaka 70-80 of plasmapheresis ubelokhu esetshenziswa e-US kanye yatha- e-USSR. Kodwa conclusiveness ukusebenza indlela has okwamanje okusezingeni eliphezulu ngokwanele, ngoba zokwelapha ezidinga iminyaka eminingi emsebenzini. Nokho, ososayensi ungazange umhlalaphansi futhi waqhubeka efunda plasmapheresis. Lokho kwaletha esintwini? Ososayensi ukuphikelela wanika imithi ngendlela ephelele futhi ephumelelayo ukuhlanza igazi. Okwamanje ukususwa "okunobuthi" plasma kubhekwa indlela ephumelela kakhulu uthi abaningi sokugembula okuyinto ahambisana ahlukahlukene intoxications umzimba.

Yiziphi izinhlobo nezindlela ezikhona plasmapheresis

Kunezinhlobo ezintathu oyinhloko plasmapheresis.

1. ngu aphoyintimenti

Uma igazi uhlanzekile kuyinto zokwelapha ngokwemvelo futhi isetshenziselwa ukukhipha yisiphi isifo noma isimo, kuba - plasmapheresis zokwelapha. izakhi okwenyanga ehlungiwe Ngakho kuthiwa libuyiselwa esigulini, kanye plasma esikhundleni igazi noma isixazululo ekhethekile.

Uma ukwehlukana igazi uqhutshwa ukuthola plasma kusuka umuntu enempilo ukusetshenziswa eyengeziwe, inqubo enjalo ibizwa ngokuthi plasmapheresis abanikelayo.

2. Ngokuphambene

Kukhona plasmapheresis leyehlukene kanye othomathikhi. Esimweni sokuqala isiguli uthethe isamba esikhulu igazi ibekwe endaweni esitsheni oyinyumba nge nezivimbelakuvunda nokuziphatha plasma ukuhlukaniswa by centrifugation noma kwezulu. Khona-ke isiguli injected ngemithambo yegazi ezisele ngemuva ukususwa yengqamuzana plasma, buhlanjululwe nosawoti. Le ndlela ebuye ibizwe ngokuthi bhukwana.

Nge othomathikhi plasmapheresis igazi iqoqo, filtration bese ulithumela isitsha labetibambile izingxenyana ezincane esebenzisa idivayisi ngokuhlukana. Ngaphezu kwalokho, zonke izinqubo uze uyophela golokoqo. Le ndlela kuyinto ukhululekile esengeziwe isiguli mobile okuningi iphinde ivimbele lokulimala kwamangqamuzana, njengoba kuqhathaniswa manual.

3. Ngokususa indlela kanye ukucutshungulwa plasma

Kuye inqubo lapho ingxenye ewuketshezi isuswe, plasmapheresis uhlukaniswe:

• I Centrifuge.
• Ulwelwesi.
• Threaded.
• Sedimentation (bezapparatny plasmapheresis).
• Krioplazmaferez.

indlela ngayinye ine, ubuhle nobubi bayo. Ethandwa kakhulu ubhekwa plasmapheresis ulwelwesi. Sedimentation ndlela cishe ayisetshenziswa, kodwa kuba ishibhile kunabanye.

Incazelo izinqubo

Indlela Centrifuge kusekelwe imithetho gravity. Idivayisi inikeza igazi uphendukisa ngesivinini, kangangokuba yizingxenye. izakhi okwenyanga Ngakho phinda umzimba, kanye plasma isusiwe. Le ndlela akusebenzi, it has eziningi Izimo, ngaphezu kwalokho, ngokuvamile kwenzeka ngesikhathi centrifugation iseli ukulimala.

Ulwelwesi indlela kuhilela ukusetshenziswa apharathasi ifakwe izihlungi obukhethekile ikhule ezimbotsheni okuyinto ukuvumela plasma, izakhi kwakhiwa futhi ukubambezeleka. Le nqubo kunezinzuzo zako:

• Inzalo plasmafilters.
• Ukuvikelwa ezifweni.
• I rapidity indlela.
• Bambalwa Izimo.
• Amaseli azilimele.
• Kungenzeka isicelo inqubo yokwelapha zabasiza abathile abanomdlavuza.

indlela Threaded ungachazwa ukuthi igazi sihamba ukucutshungulwa double. Okokuqala, i-mass cell ahlukaniswa kanye plasma ke kuhlungwa ehlambulula molecule ezinkulu, amaprotheni lipids. Le nqubo kuyaziwa ekwelapheni isifo sokuqina kwemithambo yegazi.

Bezapparatny plasmapheresis (noma sedimentation) Kwenziwa ngaphandle kokusebenzisa yimaphi amadivayisi ezikhethekile. Igazi ahlukaniswa ngezigaba ezimbili ngaphansi kwethonya adonsela phansi. Lena plasmapheresis ilula kakhulu futhi engabizi. intengo yaso ngokuphongoza izindleko ezinye izindlela. Kodwa akasivumeli ukucubungula Imiqulu emikhulu yegazi.

Krioplazmaferez kuhilela ukususwa plasma kusuka eqandisiwe kwayo -30 ^{° C,} kulandele ukufudumala kuya 4 ^{° C} kulandele centrifugation. Ingxenye ketshezi okuyinto ukugqashuka isuswe, futhi plasma asele ebuyiselwa bese libuyiselwa esigulini.

Umthelela bokuphila inqubo

inqubo plasmapheresis ivumela ukusula umzimba imikhiqizo asalile lokugayeka kokudla (urea, creatinine, uric acid), amasosha omzimba, antigen, amahomoni, macromolecular balamuli lipid ukuvuvukala kanye nezinye izinto eziyingozi. Ukususwa plasma yokufakelwa kubangela hypovolemia ukuthi kuphakamisa compensatory kanye iinthombe wonke umzimba ozivikela ngayo. Ngaphezu kwalokho, uketshezi odlula ezicutshini zomzimba zibe nezitsha ukubuyisela afundwa umthamo wegazi. Lokhu kuholela ukwehla ukuvuvukala futhi kunciphisa imiphumela anobuthi ezingcolisayo emahoreni ambalwa.

Nokho, ngelinye ilanga abashayeli isamba ubuthi egazini kubuyiselwa futhi. Ngakho-ke, ochwepheshe batusa plasmapheresis Yiqiniso, eyenzelwe 3-4 ukuvakashelwa. Nge ngamunye ezingeni ezilandelanayo inqubo entsha sihlanza ezitsheni kuqala, bese indwangu, bese iseli. I izakhiwo rheological wegazi baguqulelwa ohlangothini omuhle, ekuqedeni viscosity ngokweqile, kukhuphuke ukugeleza kwegazi ne-oksijini ligeleze kwezitho nezicubu. Lokhu kuqinisekisa ngcono isimo jikelele umzimba, ukwandisa amakhono oluhambelana, futhi kususa eziyingozi izimpawu compounds ukudakwa.

Nokho, ukuthembela kuphela plasma exchange akudingekile, ngoba kubalulekile ngaso sonke isikhathi ukuba afeze ukwelashwa olunzulu yisiphi isifo, kulandela oda udokotela.

Ukuze abonise le nqubo

Manje, odokotela abaningi linqume plasmapheresis. Kuyini lokhu inqubo - iziguli eziningi nakuqaphela. Nokho, ukwazi ngaphansi lokho nakanjani kudingeka izimo ezidingekayo ukuze kuvunyelwane indlela yokwelashwa. Plasmapheresis - ukuhlanzwa komzimba, okuyinto Kunconywa for ekwelapheni cishe yonke kwezitho zomzimba kanye nezinhlelo. Nokho, kukhona eziningi pathologies lapho ukwelashwa plazmoobmenom kuyinkomba ngokuphelele. Lokhu kusho ukuthi ukwehluleka inqubo kungaholela ekufeni isiguli. Izifo ezihlala zihlanganisa:

• isikela cell anemia ;
• thrombocytosis futhi leukocytosis;
• erythroleukemia;
• porphyrin isifo;
• hypercholesterolemia (lezinceku);
• isifo Rufus sika;
• DIC;
• syndrome hyperviscous;
• myasthenia gravis;
• Guillain-Barre syndrome;
• imisiwe thrombocytopenia;
• mioglobinemiya;
• hemolysis intravascular;
• Goodpasture Syndrome ;
• Gasser Syndrome;
• thrombotic purpura thrombocytopenic;
• cryoglobulinemia;
• polyneuropathy ezingamahlalakhona;
• ubuthi ubuthi.

izinkomba Isihlobo ngoba plasmapheresis yilezi:

• Pathology yokusetshenziswa pheshana emathunjini: izilonda emathunjini, isifo Crohn.
• zibangele isifo senhliziyo: isimo ngemva kokushaywa yinhliziyo, myocarditis, rheumatism nokunye.
• Yokungezwani komzimba: deramatit atopic, pollinosis nabanye.
• izifo dermatological: psoriasis, pemphigus, i-herpes, njll
• isifo so-renal: Glomerulonephritis, pheshana urinary ukutheleleka, kanjalonjalo.
• Izifo umgudu wokuphefumula: isifuba somoya, hemosiderosis.
• izinkinga Isibindi: i-hepatitis sokuhlasela kwamasosha omzimba kanye nabanye.
• yezinkinga Septic ngemva kokuhlinzwa.
• vasculitis lefundo.
• izilonda Toxic in Oncology.
• Isifo sokuqina kwemithambo yegazi.

Muva nje, gynecologists ukweluleka imali plasmapheresis ngesikhathi sokukhulelwa uma owesifazane ehlupheka toxicosis, kukhona Rhesus ukungqubuzana noma esingamahlalakhona fetoplacental. Lolu hlu lide kakhulu. Phela, kukhona abangaba ngu-200 izifo lapho kungenziwa ngokuphumelelayo esetshenziswa plasmapheresis. Izimo kule ndlela futhi ziyatholakala.

Ubani kudingeke uwuyeke inqubo enjalo

Ukuze le nqubo, azikho Izimo eziningi. Kodwa-ke akuvumelekile ukuba afeze ebukhoneni izilonda engelapheki kwezitho, hhayi wayeka ukopha coagulation isiyaluyalu nayo isilonda esiswini.

Akunconyelwe ngegazi lenkawu ayephuli isigqi kwenhliziyo, umfutho okhuphuka ngokungazelelwe, ekunciphiseni viscosity igazi maqondana nokuya esikhathini, izifo sibi ezithathelwanayo, hypoproteinemia, anaemia ezigulini esezikhulile, izinhlobo ezahlukene ukushaqeka, ezinzima isibindi isifo, emithanjeni "okubi".

Kwakuvamise ukuba ukuthi plasmapheresis ngesikhathi ukhulelwe eyingozi empilweni yengane, kodwa ucwaningo lwakamuva kubonisa ukuthi akalenzanga. Ngokwemvelo, isihloko inqubo ngokuqinile ebufakazini ulandele iziyalezo ezikuyo.

Ngakho, abanye isimo ayakwenqabela ukusetshenziswa plasmapheresis njengoba indlela yokwelapha. Izimo kufanele ahlolwe udokotela ukuba khona, ikakhulukazi uma kukhona ingozi Ukuwohloka impilo lesiguli uma ukwehluleka inqubo.

Indlela therapy

Ukuze plasmapheresis akudingi ukuqeqeshwa okukhethekile. Ngokuvamile inqubo yenziwa amahhovisi ekhethekile zokukhwabanisa noma ngqo egumbini lesiguli. Ukuze wenze lokhu, isiguli amanga embhedeni ekhethekile futhi kuthatha isikhundla ukhululekile. Kuye indlela, ipayipi ekhethekile (fleksulyu) iqondiswa ezandleni elilodwa noma amabili. Ngokuvamile lokhu kwenziwa kusetshenziswa umthambo bend we indololwane. Uma isiguli ngisesimweni esibucayi, i-ipayipi ibekwe ku vein subclavian. Ukuze igazi akusho clot futhi thrombus kwakhiwa, ngaphezu fleksulyu heparin iqondiswa.

Inqubo sithatha amahora mayelana 1-2. It incike indlela kanye nenani igazi ukuba zihlanzwe. Phakathi naso sonke manipulations isiguli njalo ngaphansi kweso lwezokwelapha. Walinganisa ukushaya kwenhliziyo ngamandla, umfutho wegazi, emishinini yokuphefumula kanye kuhlolelwe umoya-mpilo umncane ezicutshini.

Apparatuses ngoba plasmapheresis kukhona ephathekayo noma umile. Eyokuqala zibelula ngoba uyiswe kunoma iyiphi indawo esibhedlela noma ekhaya ukuze isiguli. Idivayisi ethatha igazi portionwise nge mayelana 40 ml ngesikhathi, ahlanze sibuyisela emuva ngokusebenzisa ipayipi Njalo athathe igazi. Amanye amadivayisi zisebenzisa ekuphathweni ngokuzenzekelayo anticoagulants. Ngomzuzu owodwa, apharathasi plasmapheresis uyakwazi ukucubungula mayelana 100 ml igazi, isb. E. Per ihora Ungasusa mayelana 800 ml uketshezi ngokweqile.

Ochwepheshe batusa ekususeni kokuhlanganyela bangaphasi kwekota plasma circulating. Odokotela balindele ukuthi lesi sibalo kuye ngomuntu ngamunye: isisindo kanye igazi ivolumu (CBV).

It is ukuthi plasma kuyinto 55% BCC ezaziwayo. Futhi ukuze sithole isibalo yokugcina, kubalulekile ukuba uphindaphinde komzimba 75. Ngokwesibonelo, umuntu enesisindo 80 kg kwelinye session ukuthi ufuna ukususa inombolo elandelayo plasma:

80 x 75 x 825 ml = 0,55h0,25.

Kubalulekile ukuhambisana nayo yonke olinganise, eqhuba plasmapheresis. Izinzuzo kanye efanele ibe kuhlu lokuhlukumezeka of amasu zokwelapha kuzoncika ezintweni eziningi, kuhlanganise ukunemba izibalo.

Can plasmapheresis ubuhlungu?

Muva nje, le nqubo eqolo ibekwe njengoba panacea for zonke izifo. emitholampilo yangasese ikakhulukazi asebenzayo ekukhuthazeni plasmapheresis. Izinzuzo kanye efanele ibe kuhlu lokuhlukumezeka le ndlela kuyinto encike ngqo kwi nobuchwepheshe odokotela. Kodwa njenganoma iyiphi indlela yokwelashwa, it has imiphumela engemihle nemibi:

• ukushaqeka Anaphylactic.
• Yokungezwani komzimba ukuze plasma donor futhi eshintsha ngayo uketshezi.
• Sokuhlasela kwamasosha omzimba isifo sezinso ngenxa yokuphatheka ukuze donor-plasma.
• Ukutheleleka kusukela donor-plasma.
• Ukuthuthukiswa sepsis elandelayo izilinganiso aseptic.
• Ukopha (uma kukhona izinkinga kanye ekunqandeni).
• Thrombosis (nge lingabhekiseli anticoagulants).
• bebek blood pressure.
• Ukususwa ubuthi nje kuphela kodwa futhi izakhi kanye plasma.
• Yehlela amasosha omzimba.
• disorder umzimba kanye nenani lwemithi egazini.
• Isicanucanu.
• Ubuhlungu bekhanda.

Lena inqubo sibi kakhulu futhi kuyinkimbinkimbi, ngakho kudingeka uqaphe lapho ukhetha indawo ukuze bayothola ukwelashwa. Izibhedlela eziningi zangasese banikeza iziguli plasmapheresis. Hlobo luni izikhungo lapho ochwepheshe ukusebenza khona, kungakhathaliseki ukuthi isinqumo kukhona inqubo? Zonke-ke idinga ukwazi ngaphambi kokuvuma ukuba ukuphathwa, ukuze singathwesi ukuwela ezandleni imikhonyovu abangafundile. Phela, kungaholela umphumela oyinhlekelele.

Yini imiphumela ongayilindela

Ukuphumelela plasmapheresis wazibonakalisa esimweni izifo eziningi. Njalo fixed omuhle inqubo ukusebenza ngisho nalapho izimpawu isihlobo. Nokho, kufanele kuqondwe ukuthi monotherapy kungase kungasheleli ngaso sonke ukusiza. Ngakho-ke, kubalulekile ukuthi uthathe ukuphathwa oluphelele kusuka ochwepheshe abafanelekayo, ngaphandle ukuthembela ukuphulukiswa inkambo eyodwa ekususeni plasma.

Ukuze zithole imiphumela emihle, kumele ube nesiqiniseko sokuthi izinga lokunakekelwa kanye ahlolwe kwangaphambilini ukuqinisekisa ukungabi khona contraindications ukusetshenziswa okunjalo amasu zokwelapha ezifana plasmapheresis.

Intengo yale nqubo impela high (4500-5500 THS. Ruble), kanti isiguli kuzodingeka ezingaphezu kweyodwa noma ezimbili, futhi 3-4 izikhathi, kungenjalo abelashwayo angeke Akunangqondo. Lokhu kufanele kubhekwe. Nokho, imitholampilo eminingi zinikeza izaphulelo uma isikhathi of the Yiqiniso ingaphezu 5 izikhathi. Kumele kuqashelwe ukuthi le nqubo akukwazi ezishibhile, t. Ukuze. I ngamathuluzi nangezinto zokwakha manje ngempela eqolo. Ngakho musa uthemba umtholampilo lapho inqubo wenziwa ngentengo ephansi kakhulu.

Kufinyeta

Yebo, le ndlela yokwelapha libuhlungu ephaketheni lesiguli, kodwa kuwufanele umzamo. Intuthuko isimo jikelele, iinthombe imisebenzi zokuzivikela futhi compensatory, ukuzinza nemingcele rheological wegazi, ukususwa izimpawu zokudakwa - lokhu akulona uhlu oluphelele igalelo elihle sisuke sicabanga inqubo emzimbeni.

Plasmapheresis - indlela ezintsha esisiza iziguli eziningi abhekane nokugula kwabo futhi ukuhlanza igazi kusukela "okunobuthi" plasma. Le nqubo kuboniswa ngenxa lenqwaba izifo futhi has Izimo ezimbalwa kakhulu. Ukuqala kokusetshenziswa plasmapheresis ngosizo ochwepheshe abafanelekayo futhi kuhambisana Nomgomo yonke imiyalelo ukuhoxa imiphumela emihle ekwelapheni ngisho izifo ezingavamile kakhulu.