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"Emergency medicine" 7 (70) 2015

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Role of Active Methods for Detoxification of Body in Intensive Therapy of Newborns

Authors: Danylova V.V. - Kharkiv National Medical University, Ukraine

Categories: Medicine of emergency

Sections: Clinical researches

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Summary

В статье отражены результаты исследования эффективности различных методов детоксикации организма при синдроме эндогенной интоксикации у новорожденных. Дана сравнительная оценка эфферентных методов по кинетике основных биохимических показателей интоксикации и концентрационным порогам основных клинических симптомов.

У статті відображені результати дослідження ефективності різних методів детоксикації організму при синдромі ендогенної інтоксикації у новонароджених. Наведена порівняльна оцінка еферентних методів з кінетики основних біохімічних показників інтоксикації і концентраційних порогів основних клінічних симптомів.

The paper deals with the results of the study of efficiency of various methods of detoxification of a body in syndrome of endogenous intoxication in newborns. There is presented the comparative estimation of efferent methods on kinetics of basic biochemical parameters of intoxication and concentration thresholds of key clinical symptoms.


Keywords

новорожденные, синдром эндогенной интоксикации, уровень среднемолекулярных пептидов, гемосорбция, плазмаферез, ультрафиолетовое облучение аутокрови.

новонароджені, синдром ендогенної інтоксикації, рівень середньомолекулярних пептидів, гемосорбція, плазмаферез, ультрафіолетове опромінення автокрові.

newborns, syndrome of endogenous intoxication, level of medium molecular peptides, hemosorption, autoblood uviolizing.

One of the major syndromes, determining the severity of the newborn's condition, is an endogenous intoxication syndrome, leading to origination of critical states, which threaten the life of the patient, and treatment of which requires the use of methods of intensive care and resuscitation. The purpose of this study was to investigate the effect of different methods of active detoxification upon this syndrome in newborns. We analyzed 112 case histories of newborns with the endogenous intoxication syndrome of the severe degree, who underwent the complex intensive therapy which included efferent methods of detoxification: exchange blood transfusion, hemosorbtion, plasmapheresis and hemosorbtion in conjunction with ultraviolet irradiation of autoblood, with the application of the procedures adapted for a neonatal period. 
An evaluation of the effectiveness of methods of the efferent therapy of  the endogenous intoxication syndrome was carried out with quantitative assessment of the kinetics of basic biochemical indicators and the definition of their half-life, as well as alterations of concentration thresholds of the main pathological symptoms. 
According to the results of our study, the most efficient detoxification method proved to be plasmapheresis, the effectiveness of hemosorption and exchange blood transfusion was equivalent, but in comparison with plasmapheresis it was lesser. The most effective was found to be a complex method of detoxification when ultraviolet irradiation of autoblood preceded hemosorption. It was determined that patients with repeated application of the method of an active detoxification the appearance of specific clinical signs of endotoxicosis was conditioned not only by quantitative level of plasma "middle molecules", but the duration of their circulation in biological fluids of the body as well. Clinical evaluation of the comparative effectiveness of active methods of detoxification of the organism was carried out on the base of concentration threshold levels of "middle molecules ". A positive effect was ascertained in the case when there was an increase of the concentration thresholds in comparison with the standard response. There was found on comparison of the obtained data that all methods of the active detoxification without exception were accompanied by elevated concentration thresholds of clinical signs of endotoxicosis. The highest concentration threshold shift was detected when using hemosorption that reflected greater clinical efficacy in comparison with other methods of the active detoxification. 
The findings strongly suggest that all applied methods of detoxification increase the general body's resistance against effects of a high concentration of "middle molecules". Comparative assessment of efferent methods of detoxification grounded on the kinetics of the "middle molecules" and concentration threshold of major clinical symptoms showed the advantage of using sorption detoxification combined with ultraviolet irradiation of autoblood, while plasmapheresis is the following.

Bibliography

1. Данилова В.В., Межирова Н.М., Острик А.Е., Шевченко О.А. Клиника и лечение синдрома эндогенной интоксикации ІІІ степени у новорожденных с хирургической патологией // Матеріали наук.-практ. конференції Асоціації анестезіологів України, 26–27 вересня 2002 р., м. Свалява. — С. 21-24.
2. Келина Н.Ю., Васильков В.Г., Безручко Н.В. Методология доказательной биохимической оценки развития эндотоксикоза // Вестник интенсивной терапии. — 2002. — № 4. — С. 13-17.
3. Межирова Н.М., Данилова В.В., Овчаренко С.С. Патофизиологические и диагностические аспекты синдрома системного воспалительного ответа // Медицина неотложных состояний. — 2011. — № 1–2(32–33). — С. 34-40.
4. Шикунова Л.Г. с соавт. Системный подход к оценке синдрома эндогенной интоксикации у больных с разлитым перитонитом // Труды Института общей реаниматологии РАМН. — М., 2000. — Т. 1. — С. 98-100.

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