Plasmapheresis - ntoni na? Plasmapheresis: inzuzo kunye ububi, Izimo, amaxabiso kunye neendlela. plasmapheresis therapeutic

Iikliniki ezininzi kule minyaka ilishumi idluleyo, baqala ukunikela inkqubo esixabiso likhulu - plasmapheresis. Yintoni na loo nto, yaye oko kuboniswa phantsi ntoni izifo? Ingaba le ndlela kuyingozi kwaye wachitha njani? Nantsi imiba ephambili ezivelayo izigulane xa singacebisi indlela ezintsha yokuhlambulula igazi "slags".

Yintoni plasmapheresis?

Le ndlela mihla nyulu umzimba kwinqanaba zeselula Internet igazi usebenzisa izixhobo ezikhethekileyo. Kujongwe ukuba unyango lwezifo ezininzi kwaye usindiso kuphela amanye izifo ezinqabileyo. Igama elithi "plasmapheresis" iquka lamagama amabini - ". Ukususwa plasma" "ububomvu" kunye "apheresis 'ukuba Latin linokuguqulelwa njengoko

Le nkqubo lwaqhutywa kwizibhedlele zikarhulumente, iikliniki abucala kwaye maxa wambi ekhaya. igazi Plasmapheresis ukuqondwa efunyenwe ekupheleni kwenkulungwane yokugqibela, kodwa sele ikwazile ukugcina amakhulu amawaka impilo yabantu.

History of indlela imvelaphi

Le ndlela lisukela emva ukusetyenziswa kwegazi-ukuqeshiswa njengonyango lwe nasiphi na isifo. Kangangexesha elide, ngale ndlela 'okungenaluzsini "unyango lilityelweyo ngoogqirha, kodwa ngenkulungwane XX phakathi, iingcali ndiqalile ukuzama ukudala isixhobo eyahlula igazi ngezigaba kunye nokususwa inxalenye yayo engamanzi ukuvelisa isiphumo therapeutic.

Sele kule minyaka 70-80 of plasmapheresis ubesoloko ethatha ezisetyenziswa kwi-US kunye wazuza kuthandwa kwi-USSR. Kodwa ke conclusiveness ukusebenza le ndlela iye kodwa phezulu akwanelanga, ngenxa yokuba ulingo lonyango ifuna iminyaka emininzi yomsebenzi. Noko ke, izazinzulu ziye nto umhlala saqhubeka nokufunda plasmapheresis. Yintoni basisa uluntu? Izazinzulu yokuzingisa wamnika amayeza ngendlela egqibeleleyo nesebenzayo ukuba ukucoca igazi. Okwangoku ukususwa "ezingcolisekileyo" plasma kugqalwa indlela ephumelelayo kakhulu kumazwe amaninzi zophendlo lwezifo ezo zihamba ezahlukeneyo intoxications ephilayo.

Ziziphi iintlobo kunye neendlela zikhona plasmapheresis

Kukho ukuhlelwa ezintathu ezingundoqo plasmapheresis.

1. Ngo ukuqashwa

Ukuba zokuhlanjululwa igazi le zonyango ngokwendalo kwaye kusetyenziswa ukususa nasiphi na isifo okanye imeko, oko - plasmapheresis therapeutic. izinto ezime Ngaloo ecociweyo zibuyiselwa kwisigulana, kwaye plasma indawo igazi okanye isisombululo okhethekileyo.

Ukuba ukwahlulwa igazi lwenziwa ukufumana plasma kumntu usempilweni ukusetyenziswa ngakumbi, le nkqubo ibizwa ngokuba plasmapheresis kubalizi.

2. Xa indlela

Kukho plasmapheresis ezahlukene kanti automatic. Kwimeko yokuqala isigulane uthathe isixa elininzi igazi ibekwe kwisingxobo engenazintsholongwane kunye kwisigcinakaliso kunye nokwahlukana yokuziphatha plasma ngu centrifugation okanye kwezulu. Ngoko ke isigulane lesitofu yegazi eseleyo emva kususwa weseli ubunzima plasma, exutywe saline. Le ndlela ukwabizwa ngokuba manual.

Okuzenzekelayo plasmapheresis yokuqokelela igazi, ukuhluza uze uyibuyisele kwi inkonkxa agcinwe ngokusebenzisa isixhobo ukwahlukana iinxalenye ezincinane. Ngaphezu koko, zonke iinkqubo ezenzekayo rhoqo. Le ndlela ukhululeke ngakumbi ukuba isigulana mobile kakhulu ngakumbi kwaye kuthintela umonakalo kwiiseli, njengoko kuthelekiswa ncwadana.

3. Xa ngokususa indlela kunye processing plasma

Kuxhomekeka ubuchule ngayo isahlulo ulwelo lisusiwe, plasmapheresis yahlulahlulwe:

• Le icentrifuge.
• Ndizayo.
• Azinamsonto.
• Intlenge (bezapparatny plasmapheresis).
• Krioplazmaferez.

indlela ngamnye ubuhle nobubi bayo. Ethandwa kakhulu ithathwa plasmapheresis ndizayo. indlela Intlenge cishe ayisetyenziswa, kodwa kutshiphu kakhulu kunabanye.

Inkcazelo iinkqubo

Indlela icentrifuge isekelwe phezu imithetho womxhuzulane. Le fowuni inika igazi phendula ngesantya esiphezulu, ukuze ukuba yahlulwe amaqhezu. izinto ezime Ngaloo zibuyiselwa umzimba, kunye plasma isusiwe. Le ndlela akusebenzi, it has a lot of Izimo, kananjalo, kaninzi kwenzeka ngexesha iseli centrifugation kukwenzakala.

indlela inwebu kubandakanya ukusetyenziswa izixhobo baxhotyiswa okucoca ezizodwa pores leyo avumele plasma, izinto ibunjiwe ulibaziseko. Le nqubo iye zalo eziluncedo:

• plasmafilters inzalo.
• Ukhuseleko kwizifo.
• Le wathandwa le ndlela.
• Zimbalwa Izimo.
• Iiseli ngeke yonakele.
• Ithuba isicelo inkqubo unyango izigulane ezinomhlaza.

indlela yangaphakathi ungachazwa ukuba igazi udlula processing kabini. Okokuqala, ubunzima iseli abazahlulayo kwaye plasma ke ahluzwe ezihlambulule molekyuli ezinkulu, iiproteni kunye lipids. Le ndlela ithandwa kunyango ngenxa yamafutha.

Bezapparatny plasmapheresis (okanye neentlenge) yenziwa ngaphandle kokusebenzisa naziphi na izixhobo ezikhethekileyo. Yegazi abazahlulayo ngezigaba ezibini phantsi kwempembelelo womxhuzulane. Le plasmapheresis ilula kakhulu kwaye azibizi. ixabiso layo yahluke kakhulu ukusuka iindleko kwezinye iindlela. Kodwa akavumeli ukusebenza imithamo ezinkulu igazi.

Krioplazmaferez kubandakanya ukususwa plasma ukusuka frozen yawo -30 ^{° C,} kulandele esotha ku-4 ^{° C} ilandelwa yi centrifugation. Inxalenye engamanzi ezenze isusiwe, kwaye plasma eliseleyo ibuyiselwe umva kumguli.

Isiphumo komzimba kwale nkqubo

Inkqubo plasmapheresis ivumela ukuba ukucima umzimba yemveliso intsalela yokutya emzimbeni (urea, creatinine, uric acid), izilwa-buhlungu, ezisegazini, iihomoni, mediators macromolecular lipid of ukudumba kunye nezinye izinto eziyingozi. Ukususwa plasma ngumntu ebangela hypovolemia ukuba kuphakamisa zembuyekezo kunye lokuquka bonke zokuzikhusela zomzimba. Ukongeza, ulwelo Lisuka ukusuka kwinyama zibe iimpahla ukubuyisela ajikelezayo umthamo wegazi. Oku kukhokelela ekuncipheni ukudumba kwaye kunciphisa iimpembelelo enetyhefu ukungcola e iiyure ezimbalwa.

Noko ke, ngenye imini isixa ubuthi igazi edlulileyo izakugcinwa kwakhona. Ngoko ke, iingcali bacebisa ikhosi plasmapheresis, ezenzelwe ukulungiselela utyelelo 3-4. Nenqanaba ngalinye ezilandelelanayo inkqubo entsha icocwe, migqomo kuqala, ngoko ke ilaphu, uze iseli. Iimpawu rheological yegazi zitshintshiwe kwicala entle, ukuphelisa viscosity ngokugqithiseleyo, flow yegazi eyonyukileyo kunye flow ioksijini Amalungu nezihlunu. Oku kuqinisekisa ukuphucuka nemeko ngokubanzi kumzimba, ukwandisa izakhono okulungisekayo, kwaye kususa iimpawu iikhompawundi ukunxila yingozi.

Noko ke, sithembele kuphela kutshintshiselwano plasma yegazi ayikho kuyimfuneko, kuba usoloko kubalulekile ukwenza unyango ebanzi nasiphi na isifo, ukulandela imiyalelo kagqirha.

Ukubonakalisa le nkqubo

Ngoku, oogqirha abaninzi ukumisela plasmapheresis. Yintoni na le nkqubo - izigulane ezininzi musa nakubona. Ukanti, ukuba ukwazi phantsi kwaziphi iimeko eziyimfuneko ukuze kuvunyelwane indlela yonyango ngokuqinisekileyo efunekayo. Plasmapheresis - ukuhlanjululwa emzimbeni, nekucetyiswa ukuba unyango phantse onke amalungu oluntu kunye neenkqubo. Nakuba kunjalo, kukho iqela ezimbi apho kunyango plazmoobmenom kubonisa ngokupheleleyo. Oku kuthetha ukuba ukungaphumeleli nkqubo kungakhokelela ekubeni ukufa isigulane. izifo ezifana ziquka:

• cell anemia irhengqa ;
• thrombocytosis kunye leukocytosis;
• erythroleukemia;
• porphyrin izifo;
• hypercholesterolemia (amafa);
• isifo uRufus kaThixo;
• DIC;
• syndrome hyperviscous;
• myasthenia gravis;
• syndrome Guillain-Barre;
• imisiwe thrombocytopenia;
• mioglobinemiya;
• hemolysis intravascular;
• syndrome Goodpasture kaThixo ;
• syndrome Gasser kaThixo;
• purpura thrombocytopenic thrombotic;
• cryoglobulinemia;
• polyneuropathy ezingapheliyo;
• yonakalisa ityhefu.

eziveza Relative for plasmapheresis zezi:

• Pathology ye phecana zesisu: sisilonda sikabhobhosi, isifo Crohn kaThixo.
• isifo sentliziyo: a imeko emva ndamelwa yintliziyo, myocarditis, rheumatism njalo njalo.
• Umzimba: atopic deramatit, pollinosis kunye nabanye.
• Izifo Dermatological: ukhwekhwe, pemphigus, herpes, njl
• isifo sezintso: Glomerulonephritis, wokuchama usulelo iphecana, njalo njalo.
• Izifo isixokelelwano sokuphefumla: sombefu, hemosiderosis.
• iingxaki Isibindi: hepatitis samathambo kunye nabanye.
• iingxaki yokubolisa emva kotyando.
• vasculitis zeNkqubo.
• izilonda yityhefu in Oncology.
• Yamafutha.

Kutshanje, gynecologists ukucebisa inkcitho plasmapheresis ngexesha lokukhulelwa umfazi ukuba ubandezeleka toxicosis, kukho Rhesus-ungquzulwano okanye insufficiency fetoplacental. Olu luhlu elide kakhulu. Ngapha koko, kukho izifo 200 apho zisetyenziswe ngempumelelo plasmapheresis. Izimo ngale ndlela nazo ziyafumaneka.

Ngubani ukuba balahle nkqubo

Ngenxa yale nkqubo, akukho Izimo ezininzi. Kodwa akuvumelekanga ngokungqongqo ukuba enze phambi izilonda lakho amalungu, akayekanga ukopha, coagulation sifo kunye isilonda esiswini.

Akunconywa ngegazi lenkawu olwaphula rhythm and izinga lentliziyo, yokugaleleka ngamandla, ukunciphisa viscosity egazini sexesheni, izifo ezihlasela zosulele ezosulelayo, hypoproteinemia, igazi kubantu abalupheleyo, iintlobo ezahlukeneyo bothukile, isifo kakhulu isibindi, "embi" mithambo.

Yayifudula ukuba plasmapheresis ngexesha ukhulelwe kuyingozi kwimpilo yomntwana, kodwa uphando lwakutsha nje kubonisa ngenye indlela. Ngokwendalo, isihloko inkqubo ngqongqo ubungqina kunye ngokwemiyalelo.

Ngenxa yoko, ezinye urhulumente akukuthinteli ukusetyenziswa plasmapheresis njengendlela unyango. Izimo kufuneka avandlakanywe yi-gqirha khona, ingakumbi xa kukho umngcipheko ukonakala yempilo yomguli xa ukusilela yenkqubo.

Njani na unyango

Kuba plasmapheresis ayifuni uqeqesho olulodwa. Ngokuqhelekileyo le nkqubo lwenziwa kwii-ofisi ezizodwa buqhinga okanye ngqo kwigumbi yesigulane. Ukuze wenze oku, isigulane ubuxoki kwisingqengqelo okhethekileyo kwaye athathe isikhundla obutofotofo. Kuxhomekeka kwindlela, a catheter ezizodwa (fleksulyu) elawulwa esezandleni omnye okanye emibini. Kaninzi oku kwenziwa ngokusebenzisa iphuma kwi aguqe engqinibeni. Ukuba isigulana zikwimeko kakhulu, catheter ibekwe kwi Kusenjalo subclavian. Ukuba igazi akuthethi ihlwili kunye thrombus kwasekwa, ukongeza fleksulyu lweeHedfowuni alawulwa.

Le nkqubo ithatha malunga 1-2 iiyure. Oku kuxhomekeke kwindlela kunye nemali wegazi ukuba ucocwe. Ebudeni balo lonke zazo ze isigulane usoloko phantsi kweliso zonyango. Wayilinganisa izinga ukubetha, uxinzelelo lwegazi, nokuphefumla ukuze ihlolwe ukuba ioksijini ubonelelo emzimbeni.

Kwezixhobo ze plasmapheresis abaphathwayo okanye zokubhala. Okokuqala elula kakhulu ngakumbi ngenxa yokuba kuthuthwa kuyo nayiphi na indawo esibhedlele okanye ikhaya umguli. Le fowuni ethatha igazi portionwise kunye ml malunga-40 ngexesha, ococa ibuyisela umva ngokusebenzisa catheter kwaye kwakhona athathe igazi. Ezinye izixhobo usebenzise ulawulo oluzenzekelayo anticoagulants. Ngomzuzu omnye, izixhobo plasmapheresis akwazi ukusingatha malunga 100 ml yegazi, iyure okt. E. Per uyakwazi ukususa malunga 800 ml kolwelo kwemfuneko.

Iingcali Sicebisa ukususa iseshoni enye ngaphantsi kwe ikota plasma elijikeleza. Oogqirha Silindele ukuba eli nani kuxhomekeke ngamnye: ubunzima benu, umthamo wegazi (CBV).

Yinto eyaziwayo ukuba plasma yi-55% of BCC. Kwaye ukuze kumiselwe inani lokugqibela, kuyimfuneko zande komzimba 75. Umzekelo, umntu onobunzima 80 kg kwiseshoni nye ufuna ukucima inani zilandelayo plasma:

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

Kubalulekile ukuba ukuthobela zonke olinganise, eqhuba plasmapheresis. Iinzuzo tywaleni kobuchule zonyango zixhomekeke kwizinto ezininzi, kuquka ukuchana izibalo.

Ngaba plasmapheresis ubuhlungu?

Kutshanje, le nkqubo eninzi into ibekwe njenge ilikhubalo lokunyanga zonke izigulo. kwiiklinikhi zabucala kakhulu inxaxheba ekukhuthazeni plasmapheresis. Iinzuzo tywaleni yale ndlela kuxhomekeke ngqo kwi indlela entle oogqirha. Kodwa kufana nje nayiphi na enye indlela yonyango, iye neziphumo zalo nezingeloncedo:

• yashiya Anaphylactic.
• Umzimba ukuya plasma abanikelayo kwaye endaweni kuso ulwelo.
• isifo sezintso samathambo njengoko kubangelwa onikela plasma.
• Usulelo ayithabathe kwabazana plasma.
• Uphuhliso nokudumba ilandelayo emgangathweni lwe aseptic.
• Ukopha (ukuba kukho iingxaki ekunqandeni).
• Thrombosis (ngokunge- nokusebenzisa anticoagulants).
• imenyu wegazi.
• Ukususwa kuphela ubuthi kodwa izondlo kunye plasma.
• Okha nezifo.
• sifo umzimba kunye nenani amayeza egazini.
• Isicaphucaphu.
• Intloko ebuhlungu.

Le nkqubo kunobuzaza kakhulu futhi nzima, ngoko ke kufuneka silumke xa ukhetha ibeyindawo unyango. izibhedlele ezininzi zabucala iziguli plasmapheresis. Luhlobo olunjani amaziko apho iingcali zisebenza khona, nokuba sigqibo le nkqubo? Konke oku kufuneka ukwazi phambi kokuba livume ukwenza unyango, ukuze iwele ezandleni maqhinga abangafundanga. Ngapha koko, oko kunokukhokelela isiphumo eyingozi.

kulindeleke ntoni iziphumo

Nokulunga plasmapheresis ndizilingile kwimeko nezifo ezininzi. Rhoqo esisigxina Inkqubo vuyelo lebyinene kwanaxa okukhomba isihlobo. Noko ke, kufuneka kuqondwe ukuba monotherapy akasoloko kunceda. Ngoko ke, kubalulekile ukuba uthathe unyango olunzulu iingcali abafanelekayo, ngaphandle ukuthembela ukuphiliswa ukusuka kwindlela enye wokususa plasma.

Ukuze kuphunyezwe iziphumo ezilungileyo, kufuneka ube makaqinisekise ngokumalunga nomgangatho unonophelo bangenele uviwo lokuqala ukuqinisekisa nokungabikho Izimo nokusetyenziswa kobuchule zonyango ezifana ezifana plasmapheresis.

Ixabiso le nkqubo kakhulu eliphezulu (4500-5500 ths. Engange), kwaye isigulane kuya kufuneka iiseshoni ngaphezu omnye okanye emibini, kwaye 3-4, kungenjalo unyango akayi kwenza na ngqiqo. Oku kufuneka ingqalelo. Noko ke, iikliniki ezininzi zinika izaphulelo ukuba ixesha khosi iiseshoni ngaphezulu kwe-5. Kufuneka kuqatshelwe ukuba le nkqubo ayikwazi lungabizi, t. To. Le izixhobo kunye nezinto ngoku imali eninzi kakhulu. Ngoko ke musa ukukholosa ikliniki apho lenquba yenzelwa ngexabiso eliphantsi kakhulu.

Ngamafuphi

Ewe, le unyango ibuhlungu kwipokotho yesigulane, kodwa kulungile. Ukuphucula imeko jikelele, ukuqukwa kwemisebenzi zokuzikhusela zembuyekezo, kuqheleke rheological Ipharamitha igazi, ukususwa iimpawu kunxilwe - oku uluhlu olupheleleyo igalelo elihle siye kuqwalaselwa inkqubo emzimbeni.

Plasmapheresis - indlela ezintsha inceda izigulane ezininzi ukumelana izigulo zabo ukucoca igazi ukusuka 'ingcolisekile "plasma. Le nkqubo eboniswe inani elikhulu kwezifo kwaye Izimo ezimbalwa kakhulu. Ukuphunyezwa plasmapheresis ngoncedo yeengcali abaqeqeshiweyo ngokuthobela yonke imiyalelo ivelisa iziphumo ezintle yonyango nkqu izifo kakhulu ezinqabileyo.