Extracorporeal detoxification is a method of treating blood by filtering through membranes by centrifugation, irradiation, and cleaning with sorbents outside the bloodstream. It is carried out in order to remove components that provoke or support the course of a particular disease. At the same time, medications are added to the blood to change its fluidity. This technique is used in various medical fields, but most often in toxicology and rheumatology.
In the positive result of treatment, the correct choice of the detoxification method plays an important role, which is determined by specialists and depends on the physicochemical properties of the toxin.
Objectives
The main goals pursued by extracorporeal detoxification are:
- Improving the levels of electrolytes, water and gases in the blood, metabolic processes, enzyme, hormonal and cellular composition;
- removal of metabolic products;
- elimination of various toxic compounds;
- decrease in cholesterol with its excess;
- removal of abnormal proteins and triglycerides from the blood, as well as circulating immune complexes, antigens, antibodies (including those working against their own tissues);
- elimination of stimulants of inflammatory reactions.
Blood purification using modern equipment allows you to selectively remove unnecessary components that provoke the development of pathological conditions in the body. In addition, this procedure allows you to enter into the blood of pharmacological preparations for the treatment of certain diseases. Thanks to such procedures, an anti-allergic, anti-inflammatory, immunomodulating and detoxifying effect is achieved.
Methods of extracorporeal detoxification help reduce the severity of the pathological process, prevent the occurrence of complications, and reduce the likelihood of a fatal outcome. The procedure also prevents the transition of the acute condition of the patient to a chronic form, helps to reduce the need for medications and prolonged hospital stay, returns lost performance and improves the quality of life of patients.
Methods of extracorporeal detoxification in emergency abdominal surgery are used very often.
This procedure can be used as the main method of therapy or included in the combination treatment. Before her appointment, a complete examination of the body, determination of the Rh factor, blood group and indicators of its composition is carried out. A coagulogram and a study for bacterial and viral infections are also prescribed.
When is extracorporeal detoxification indicated in surgery?
Indications for
A specialist can prescribe a procedure for intensive care of the following pathologies:
- antiphospholipid syndrome;
- rheumatological systemic diseases: vasculitis, arthritis, granulomatosis, lupus erythematosus, scleroderma, dermatomyositis;
- in case of poisoning with medicines, chemical compounds in industries;
- poisoning with alcohol, drugs;
- after environmental disasters;
- radiation damage to the body;
- toxicosis in pregnant women;
- rhesus conflict;
- the development of genitourinary infections;
- glomerulonephritis;
- insufficiency of the cleansing function of the liver or kidneys;
- diabetes mellitus;
- autoimmune thyroiditis;
- thyrotoxicosis;
- skin diseases: psoriasis, eczematous process, neurodermatitis, furunculosis;
- myasthenia gravis;
- polyneuropathy or polyneuritis;
- Parkinson's disease;
- multiple sclerosis;
- cirrhosis of the liver;
- pancreatitis with patches of necrosis in the pancreas;
- violation of the intestinal microflora;
- focal inflammation or suppuration in the lungs;
- atherosclerosis;
- bronchial asthma;
- myocardial ischemia;
- high blood pressure;
- hypertension.
Extracorporeal methods of detoxification in intensive care are used urgently, without diagnostic procedures, in acute emergency conditions, for example, sepsis. In emergency abdominal surgery, the procedure can be performed in conditions such as rupture of appendicitis, peritonitis, acute liver and pancreas diseases.
In addition, the use of extracorporeal detoxification methods in surgical dentistry is known: for abscesses of soft tissues of the oral cavity, jaw bones, etc.
Contraindications to the procedure
The main contraindications for extracorporeal detoxification are:
- the presence of bleeding, malignant processes in the body, as well as terminal (irreversible) conditions or complete decompensation of the circulatory system;
- allergy to plasma and its components, as well as to substances that reduce coagulation ability;
- acute infections or foci of suppuration;
- severe arterial hypotension;
- tachycardia, shock, or collapse;
- low circulating blood volume;
- phlebitis.
During pregnancy, the body cleansing procedure can be carried out exclusively in severe conditions, strictly for medical reasons, taking into account the risk-benefit ratio.
Ways
The most common methods of extracorporeal detoxification in the complex therapy of critical conditions are lymphocytopheresis, plasmapheresis, hemosorption, cryoapheresis, photopheresis, cascade filtration.
With discrete plasmapheresis, blood is taken from the patient (up to 0.8 L), placed in a special container, and then transferred to an apparatus in which it is separated by centrifugation into plasma and cells. Plasma is removed along with immune complexes, autoantibodies, metabolic products, toxic compounds, inflammatory pathogens. Instead of plasma, salt solutions, protein and colloidal components, and donor plasma are added to blood cells.
Membrane plasmapheresis
With membrane plasmapheresis for extracorporeal detoxification, two catheters are inserted into the venous system. Blood is taken from the first, it is passed through the filtration membrane and introduced back through the second catheter. This method allows you to allocate plasma, and blood cells are returned to the body. The liquid part is freed from toxins, allergic, provoking inflammation and autoimmune substances. Medicines can be injected into it, it is irradiated with laser light, ultraviolet light, and is ozonized.
Lymphocytopheresis
Lymphocytopheresis removes lymphocytes from the blood. This method is used for disorders of the immune system, excessive production of cells that destroy the body’s own tissues in the inflammatory process of an autoimmune nature. It is indicated for connective tissue pathologies. The procedure can be combined with cell activation by cytokines and blood irradiation.
Hemosorption
During hemosorption, venous blood enters the adsorbents, then is introduced back into the body. It is used in infectious and allergic processes, autoimmune pathologies (collagenosis). May be accompanied by a decrease in blood pressure, damage to blood cells and muscle tremors.
Photopheresis
During photopheresis, the patient takes drugs that increase sensitivity to light, and then outside the body, the blood is irradiated with ultraviolet rays with long waves and returns to the body. It is used for diseases of connective tissue, skin, psoriasis and fungal infections. Blood can be centrifuged, then irradiated, or these procedures are carried out on devices at the same time.
Immunosorption
During immunosorption, selective purification of blood from specific proteins - antigens, toxins, antibodies, is carried out, and its main components remain unchanged. Such a procedure is carried out for poisoning, kidney disease, allergies, autoimmune pathologies. The disadvantages of this technique are a limited number of sorbents and a rather high price.
Cryoapheresis is similar to plasmapheresis, only plasma is frozen and heparinized, cryoprecipitate is removed. It is used for atherosclerosis, eczema, gout, autoimmune vasculitis.
When is the procedure not prescribed?
Absolute contraindications to the above procedures are:
- bleeding
- severe brain diseases;
- heart failure at the stage of decompensation;
- oncological pathologies with metastases;
- neuropsychiatric diseases.
The list of relative restrictions includes:
- clotting disorders;
- arrhythmia;
- hypotension;
- decreased protein in plasma;
- digestive tract ulceration;
- infectious diseases;
- menstruation.