Plasmapheresis - chii? Plasmapheresis: kubatsirwa uye kukuvadza, contraindications, mitengo uye nzira. kuchirapa plasmapheresis

Makiriniki akawanda emazuva ano mumakore gumi apfuura akatanga kupa imwe nzira inodhura - plasmapheresis. Chii icho uye pasi pezvirwere zvipi zvinoratidzwa? Iyi nzira inokuvadza uye inoitwa sei? Iyi ndiyo mibvunzo inokosha inomuka kune varwere pavanorayirwa nzira itsva yekuchenesa ropa re "slag".

Chii chinonzi plasmapheresis?

Iyi ndiyo nzira yemazuva ano yekuchenesa muviri pamasero emasero nekusasa ropa nerubatsiro rwezvinhu zvakakosha. Yakagadzirirwa kurapa zvirwere zvakawanda uye ndiyo chete kuponeswa mune dzimwe zvirwere zvisingaoneki. Izwi rokuti "plasmapheresis" rine mazwi maviri - "plasmas" uye "apheresis", iro rinogona kushandurwa kubva muchiLatini se "kubviswa kwe plasma."

Iyo nzira inowanikwa munzvimbo dzehuruzhinji dzezvehutano, makiriniki ega uye dzimwe nguva pamba. Plasmapheresis yeropa yakakodzerwa kuzivikanwa pakupera kwezana remakore rapfuura, asi atokwanisa kugona kuchengetedza hutano kumazana ezviuru zvevanhu.

Nhoroondo yezvakabva mumugwagwa

Iyi nzira inodzokera shure panguva yekushandisa ropa kunopa mushonga wehosha chero ipi zvayo. Kwenguva yakareba, iyi "nzira isina kunaka" yekurapa yakakanganwa navanachiremba, asi nechepakati pezana remakore rechi20, nyanzvi dzakatanga kuedza kugadzira zvigadzirwa zvekuparadzanisa ropa muzvikamu uye kubvisa chikamu chayo chemvura kuti chiwane chirwere chekurapa.

Yakava mumakore 70-80, plasmapheresis yakatanga kushandiswa zvikuru muU.SA uye yakawana mukurumbira muUSSR. Asi humwe uchapupu hwekubudirira kwemuitiro wacho hwakanga husati hukwirira zvakakwana, nokuti zvidzidzo zvechipatori zvinoda makore akawanda emabasa. Zvisinei, masayendisiti haana kudzokera zvakare uye akapfuurira kudzidza plasmapheresis. Izvi zvinounza chii kuvanhu? Kushivirira kwemasayendisiti kwakapa mishonga nzira yakakwana uye inobatsira yekuchenesa ropa. Panguva ino, kubviswa kwe "plasma" inofungidzirwa senzira inobatsira zvikuru mumamiriro ezvinhu akawanda, ayo anofambidzana nekudhakwa kwakasiyana kwemuviri.

Mhando dzipi uye nzira dze plasmapheresis dziripo

Kune zvikamu zvitatu zvakakosha zve plasmapheresis.

1. Nokugadzwa

Kana kucheneswa kweropa kuchirapa muzvisikwa uye kunoshandiswa kubvisa chirwere chero chipi nechipi kana chirwere chechirwere, iyo chirwere chemaplasmapheresis. Muchiitiko ichi, iyo yakasvibiswa yunifomu inodzorerwa kumurwere wemurwere, uye plasma inotsiviwa neropa ravanopa kana sarudzo inokosha.

Kana kuparadzaniswa kweropa kuchiitwa kuitira kuti uwane plasma kubva kune munhu ane hutano kuti uwedzere kushandiswa, zvino iyo nzira inonzi anopa-plasma plasmapheresis.

2. Nenzira

Pane plasmapheresis yakanyarara uye inotsvaga. Muchiitiko chekutanga, murwere anotora ropa rinokwana yakawanda, anoisa mumhando isina kuchena yezvidziviriro uye anoparadzanisa plasma ne centrifugation kana mvura inonaya. Zvadaro murwere anopiwa intravenously yakasara masero mushure mushure mekubviswa kwe plasma, yakanatswa ne saline solution. Iyi nzira inonziwo bhuku.

Iine plasmapheresis inoshandiswa, sampuli yeropa, kusvibiswa uye kudzokera kumudziyo inogadzirwa mune zviduku zvishoma uchishandisa zvigadzirwa zvekuparadzanisa. Panguva imwe chete, zvose zvinowanzoitika zvinoenderera mberi. Iyi nzira inonyanya kusununguka kune murwere, kunyanya kushambadzira, uye inodzivirirawo kusvibiswa kwema cell, zvisingaenzaniswi nebhuku.

3. Nzira yekubviswa uye kushandiswa kwema plasma

Zvichienderana netsika iyo inoshandiswa nayo mvura yakasviba, plasmapheresis yakakamurwa kuva:

• Centrifugal.
• Membrane.
• Cascade.
• Sedimentary (nonspecific plasmapheresis).
• Cryoplasmophoresis.

Nzira imwe neimwe yevashandisi ine zvinyorwa zvayo uye minuses. Inonyanya kuzivikanwa ndeye membrane plasmapheresis. Nzira yekudzivirira muviri inenge isingashandiswi, asi inodhura kupfuura dzimwe.

Tsanangudzo yemasikirwo

Nzira ye centrifuge inobva pamitemo yekuvhenekera. Chigadzirwa chacho chinoita kuti kuve nekushanduka kweropa kunomhanya kwazvo, zvichienderana nokuti yakakamurwa kuva zvikamu zvakadini. Muchiitiko ichi, iyo yunifomu inodzokera kumuviri, uye plasma inobviswa. Iyi nzira inofungidzirwa isingabatsiri, ine zvakawanda zvinopesana, uyezve, apo centrifuging inowanzoitika masero ekukuvadza.

Nzira yemakumbo inosanganisira kushandiswa kwechigadziri chakagadzirirwa zviputa zvakakosha nema pores anopfuura neplasma, uye zvinhu zvakagadzirwa zvakanonoka. Iyi nzira inobatsira:

• Sterility of filma plasters.
• Kudzivirirwa kurwere.
• Nhanho yenzira yacho.
• Pane zvishoma zvinopesana.
• Maseji haaoni.
• Kuita kwekushandisa nzira yekurapa varwere vanorwara.

Nzira iyo inoputika inoratidzirwa nekuti ropa rinotapurirwa kaviri. Chokutanga, masero ega ega akaparadzaniswa, uye ipapo plasma inoshandiswa, yakanatswa kubva kumakura makuru, mapuroteni uye lipids. Iyi nzira yakakurumbira mukurapa kwe-atherosclerosis.

Izvo zvisina kufanana plasmapheresis (kana sedimentation) inoitwa pasina kushandiswa kwezvimwe zvinhu zvakakosha. Ropa rakakamurwa kuita zvikamu zviviri pasi pesimba rekubata simba. Iyi ipurasmapheresis iri nyore uye isingadhuri. Mutengo waro wakasiyana zvakanyanya nemari yeimwe nzira. Asi hazvibvumiri kushandisa huwandu hweropa.

Cryoplasmapheresis zvinoreva kusunurwa kwema plasma nemhepo inotonhorera paanenge yakadziya -30 ° C, uye inotonhora kusvika +4 ° C, inoteverwa ne centrifugation. Chikamu chemvura yakadzika ichibviswa uye iyo plasma inosara inodzoserwa kumurwere.

Physiological effect yemitambo

Nzira ye plasmapheresis inobvumira kuchenesa muviri wezvigadziriswa zvemishonga yemiti (urea, creatinine, uric acid), antibodies, antigens, mahomoni, high molecular lipids, vamiririri vekuputika uye zvimwe zvinhu zvinokuvadza. Kubviswa kweplasma kunokonzera hutano hwekunyengera hunoita kuti kuve nekubatanidzwa kwemasimba ose ekudzivirira uye kudzivirirwa kwemuviri. Mukuwedzera, mvura inobva mumasumbu inomhanya ichienda mumidziyo yekudzorera ivhu rekupararira ropa. Izvi zvinoita kuti kuderedzwa kwekudzivirira uye kuderedza kunhuyisa kwezvinhu zvinokuvadza kwemaawa akawanda.

Zvisinei, mushure mezuva, uwandu hwenhesi muropa hudzorerwa zvakare. Nokudaro, nyanzvi dzinokurudzira nzira ye plasmapheresis, yakagadzirirwa kutarisa 3-4. Nenzira imwe neimwe inotevera, hutsva hutsva huchagadziriswa: kutanga midziyo, ipapo mavara, ipapo masero. Zvinyorwa zvemuropa zvinoshanduka nenzira yakanaka, kuwedzerwa kwemafisikiti akawandisa kunobviswa, ropa uye oxygen inopa nhengo uye maviri anowedzera. Izvi zvinopa kuvandudza mumamiriro ezvinhu ose emuviri, kuwedzera kukwanisa kugadzirisa, uye kunobvisa zviratidzo zvekudhakwa nemakemikari anokuvadza.

Zvisinei, kuvimba chete pamaplasmapheresis yeropa hazvina kukodzera, sezvo zvichikosha nguva dzose kuita noutano hwakaoma chero chirwere chipi nechipi, kutevera zvinyorwa zvechiremba.

Ndiani anoratidzwa iyi nzira

Iye zvino vanachiremba vakawanda vanopa plasmapheresis. Ndeipi iyo nzira - varwere vakawanda havatombofungi. Uye panguva iyo, kuziva, pasi pemamiriro api izvo zvakakosha kubvumirana nenzira yakadaro yekurapa, zvirokwazvo, inokosha. Plasmapheresis iri kucheneswa kwemuviri, iyo yakakurudzirwa kurapwa kwezvirwere zvezvinenge zvose nhengo uye maitiro evanhu. Zvisinei, pane huwandu hwehutachiona hunoshandiswa pakushandurwa kweplasma inoratidzika. Izvi zvinoreva kuti kurambwa kwemitemo kunogona kutungamirira kurufu rwomurwere. Zvirwere zvakadaro zvinosanganisira:

• Sickle-cell anemia ;
• Thrombocytosis uye leukocytosis;
• Erythroleukemia;
• Porphyrin chirwere;
• Hypercholesterolemia (nhaka);
• Rufus chirwere;
• DIC-syndrome;
• Hypervisual syndrome;
• Myasthenia gravis;
• Guillain-Barre syndrome;
• Kutapera thrombocytopenia;
• Myoglobinemia;
• Intravascular hemolysis;
• Goodpasture syndrome ;
• Gasser's syndrome;
• Thrombocytopenic acroangiothrombosis;
• Cryoglobulinemia;
• Chronic polyneuropathy;
• Kusvibisa nehupfu.

Zviratidzo zvinoratidza plasmapheresis ndezvi:

• Chirwere chetachiona chepamuviri: ulcerative colitis, chirwere cheCrohn.
• Zvirwere zvepfungwa: chirwere mushure mekurwa kwepfungwa, myocarditis, rheumatism, nezvimwewo.
• Kurwara kwemhuka: atopic dermatitis, pollinosis, nezvimwewo.
• Dermatological diseases: psoriasis, pemphigus, herpes, nezvimwe.
• Kurapa kwepyiyo: glomerulonephritis, urinary tract infection, etc.
• Zvirwere zvepemhethri system: bronchial asthma, hemosiderosis.
• Zvinetso nechiropa: autoimmune hepatitis , nezvimwewo.
• Purulent-septic zvinetso pashure pekushanda.
• Systemic vasculitis.
• Zvironda zvinopisa mukenza.
• Atherosclerosis.

Munguva pfupi yapfuura gynecologists vanokurudzira kuita plasmapheresis panguva yekuzvitakura, kana mukadzi ane chirwere chekutura, pane Rh-conflict kana fetoplacental kusakwanira. Urongwa urwu runogona kupfuurirwa kwenguva refu. Mushure mezvose, pane zvirwere zvinenge 200 umo plasmapheresis inogona kushandiswa zvinobudirira. Panewo zvinopesana nemitoo iyi.

Ndivanaani vanofanira kusiya tsika iyi

Nokuda kweiyi nzira hapana maitiro mazhinji anopesana. Asi zvakarambidzwa zvachose kuitungamirira muhupo hwekuvhiringidzwa kwechimiro chisingaverengeki, uye chisina kurega kubuda ropa, kukanganisa coagulability uye gastric ulcer.

Hazvikurudzirwi kuchenesa ropa mukuputsa rhythm uye kushaya mwoyo, kupindira kunomanikidzwa, kuderedzwa kweropa maziso, kutenda kwemwedzi, zvirwere zvinotapukira zvakanyanya, hypoproteinemia, anemia kune vakwegura vakwegura, marudzi akasiyana-siyana ekutyisidzika, chirwere chakakomba chirwere, zvirwere zvakaipa.

Pamberi pacho, zvaifungidzirwa kuti plasmapheresis panguva yekuzvitakura kune ngozi kune utano hwomwana, asi kutsvakurudza kwemazuva ano kunoratidza zvakasiyana. Zvinonzwisisika, pasi pemamiriro ezvinhu ekuita zvinongoratidzwa zviri pasi pezviratidzo uye maererano nemirairo.

Nokudaro, mamwe mamiriro ezvinhu haabvumi mukana wokushandisa plasmapheresis senzira yekurapa. Contraindications inofanira kuongororwa nechiremba anoenda, kunyanya kana kune ngozi yekuderera kwehutano hwemurwere kana zvichiitika kuramba kwehutano.

Kurapa kunoitwa sei?

Nokuita plasmapheresis, hapana chigadziriro chakakosha chinodiwa. Kazhinji nzira yacho inowanikwa muzvikwata zvekushandisa zvakananga kana zvakananga muwadi yevarwere. Nokuda kweizvi, murwere anogara pasi pamubhedha chaiwo uye anotora nzvimbo yakanaka. Zvichienderana nedzimwe nzira, imwe catheter (flexure) inoshandiswa mune imwe kana maviri maoko. Kazhinji kazhinji pamusana pemishonga iyi pamakumbo. Kana murwere ari mumamiriro ezvinhu akaoma, ipapo catheter inopindirwa mumusana we subclavia. Kuchengetedza ropa kuvhara nekuvhara hazvina kuumbwa, heparin inowedzera kuiswa mukati mekushongedza.

Iyo inotora inenge inenge maawa 1-2. Izvo zvinoenderana nenzira uye simba reropa riri kucheneswa. Pakati pezvinhu zvose, murwere anogara ari pasi pekutarirwa kwachiremba. Anoyera kupisa, ropa, chengetedza kufema uye oksijeni yezvimedu.

Apparatus for plasmapheresis inoshandiswa kana inoshandiswa. Ikutanga inonyanya kukosha, nokuti inogona kutakurwa kune chero nzvimbo munzvimbo yechipatara kana kunyange kumba kumurwere. Chigadziro chinotora ropa chikamu, anenge 40 ml panguva, ichichenesa, chinounza kuburikidza ne catheter uye inotora ropa zvakare. Zvimwe zvishandise zvinoshandisa kushandiswa kwekutsvaga kweanticoagulants. Kweminiti imwechete, chigadzirwa chemaplasmapheresis chinokwanisa kushandura anenge 100 ml yeropa, kureva kuti, muawa imwechete 800 ml yemvura yakawanda inogona kubviswa.

Nyanzvi dzinokurudzira kuti hapana chikamu chechina chema plasma chinoparadzirwa chinobviswa purogiramu. Vanachiremba vanoverenga chimiro ichi zvichienderana neunhu humwe hunhu hwemunhu: kuremera uye kuwanda kwekupararira ropa (BCC).

Iyo inozivikanwa kuti plasma ndeye 55% ye bcc. Uye kuti uone chimiro chekupedzisira, iwe unoda kuwedzera muviri mashoma ne75. Somuenzaniso, munhu anorema makirogiramu 80 mune imwe sangano anofanira kubvisa chiyero chinotevera che plasma:

80 x 75 x 0.55 x 0.25 = 825 ml.

Zvakakosha kuchengeta zviyero zvose nekuitisa plasmapheresis. Izvo zvibatsiro uye marwadzo emuitiro wekurapa unotarisa pane zvinhu zvakawanda, kusanganisira kuenzana kwekuverenga.

Can plasmapheresis inokuvadza here?

Munguva pfupi iri kutevera, ino inodhura nzira yakagadziriswa sepinecea yezvirwere zvose. Makiriniki ari oga anoshanda zvikuru mukusimudzira plasmapheresis. Izvo zvibvumirano uye zvinoshungurudza zve nzira iyi zvakananga zvichienderana nehutano hwechiremba. Asi seimwe nzira ipi zvayo yekurapa, ine zvigumisiro zvayo uye zvisingabatsiri:

• Anaphylactic shock.
• Kushanda kwemvura kune anopa plasma uye kubvisa mvura.
• Kuzvidzivirira kwechirwere chekunyengedzera sekuita kwekupa mupiro plasma.
• Kurwara kubva kune anopa plasma.
• Kuvandudza sepsis kana pasina kusachengeta mitemo ye asepsis.
• Kuputa (kana pane zvinetso ne coagulability).
• Thrombosis (isina kukwana kushandiswa kweanticoagulants).
• Kurwisa ropa.
• Kubvisa kwete chete zvinodhaka, asiwo mishonga pamwe ne plasma.
• Kurara kwenguva pfupi kwekuzvidzivirira.
• Kushungurudzika kwemetabolism uye huwandu muropa rezvakatorwa.
• Nausea.
• Headache.

Iyi inenge yakakomba uye yakakomba nzira, naizvozvo unofungisisa mukusarudza nzvimbo yekurapa. Mumakiriniki akawanda ega, varwere vanopiwa plasmapheresis. Ndeapi masangano ehurumende, ndeapi nyanzvi dziri kushanda ipapo, pane chero zvibvumirano zveizvi? Zvose izvi zvinofanira kuzivikanwa vasati vabvuma kurapwa, kuitira kuti varege kuwira mumaoko evanhu vasina kudzidza. Mushure mezvose, izvi zvinogona kutungamirira kumugumisiro wakaipa.

Ndezvipi zvinotarisirwa?

Kubudirira kwe plasmapheresis kunoratidzwa munyaya yezvirwere zvakawanda. Kubudirira kwemuitiro wacho kunonyorwa nguva dzose kunyange nezviratidzo. Zvisinei, zvakakosha kunzwisisa kuti monotherapy haigoni kubatsira nguva dzose. Nokudaro, zvakakosha kuti uwane hutano hwakakwana nevadzidzisi vakagadzikana, kwete kuverenga kuporesa kubva kune imwe yeruzhinji rwekubudiswa kweplasma.

Kuti uwane migumisiro yakanaka, iwe unofanirwa kuva nechivimbo muhutano hwehutano hwakapiwa uye ugoenda kuongororwa kwepakutanga kusimbisa kuti hapana kupesana kwekushandiswa kwemaitiro akadaro ekurapa se plasmapheresis.

Mutengo weiyi nzira yakakwirira kwazvo (4500-5500 zviuru rubles), uye murwere haazodi kana imwe kana maviri, asi masangano 3-4, kana zvisina kudaro haazovi nechinangwa mukurapa. Izvi zvinofanira kuverengerwa. Zvisinei, makiriniki mazhinji anopa zvikwereti kana nguva yeiyo iri kupfuura zvidzidzo zvishanu. Zvinofanira kuonekwa kuti iyi nzira haigoni kushandiswa nokuti zvigadzirwa uye zvinhu zvino zvakadhura. Nokudaro, usavimba makiriniki, mune iyo nzira inoitwa pamutengo wakaderera.

Ngationei mhinduro

Hungu, kurapwa uku kunorwadza muhomwe yemurwere, asi zvakakosha. Kuvandudzwa kwehuwandu hwemamiriro ezvinhu, kuiswa kwezvinhu zvose zvinodzivirira uye zvinokonzera kushandiswa, kuenzanisira kwemaitiro eropa, kubviswa kwezviratidzo zvekumwa doro - iyi haisi iyo yose mhinduro yezvinobudirira zvehutano watinofunga nezvemuviri.

Plasmapheresis inzira inoshandiswa inobatsira varwere vakawanda kubata nemarwere avo uye kuchenesa ropa re "plasma" plasma. Iyi nzira inoratidzwa nehuwandu hwezvirwere uye ine zvishoma zvinopesana. Kuitwa kwe plasmapheresis nekubatsirwa kwevanyanzvi vane ruzivo uye nekuchengetedzwa kwemirairo yose kunopa migumisiro yakaisvonaka mukurapa kwezvirwere zvisingazivikanwi.