Plasmapheresis - ihe ọ bụ? Plasmapheresis: uru ma na-emerụ, contraindications, ahịa na ụzọ. ọgwụgwọ plasmapheresis

Ọtụtụ oge a na ụlọ iri gara aga, malitere na-enye a oké ọnụ usoro - plasmapheresis. Gịnị ka ọ bụ, na n'okpuru ihe ọrịa ya na-egosi? Ma usoro a dị ize ndụ na otú ọ na-nọrọ? Lee ndị isi mbipụta ndị na-ebilite ọrịa mgbe ha nwere ike ikwu na ihe otutu uzo, sachapụkwa ọbara si "slags".

Gịnị bụ plasmapheresis?

A nke oge a na usoro nke ọcha ahụ na cellular larịị site nzacha ọbara iji pụrụ iche na ngwaọrụ. Ọ na-zubere maka ọgwụgwọ nke ọtụtụ ndị ọrịa na bụ nanị nzọpụta maka ụfọdụ dị obere ọrịa. Okwu ahụ bụ "plasmapheresis" mejupụtara abụọ okwu - "plasmas" na "apheresis" na Latin nwere ike n'ụzọ nkịtị sụgharịrị dị ka "plasma mwepụ."

The usoro e rụrụ n'ihu ọha n'ụlọ ọgwụ, onwe clinics na ọbụna mgbe ụfọdụ n'ụlọ. Plasmapheresis ọbara akwụ ude na njedebe nke ikpeazụ nke narị afọ, ma ugbua jisiri ịzọpụta ọtụtụ narị puku ndị mmadụ ike.

History of si malite usoro

Nke a na usoro ụbọchị laghachi iji ọbara-esi kwere ka dị ka a ọgwụgwọ nke ọ bụla ọrịa. N'ihi na a ogologo oge, a na "obi" ụzọ ọgwụ e chefuwo site dọkịta, ma site n'etiti XX narị afọ, ndị ọkachamara na amalitela anwa ike a ngwaọrụ kewara ọbara n'ụzọ na mwepụ nke ya mmiri mmiri akụkụ na-emepụta a ọgwụgwọ mmetụta.

Ugbua na 70-80 afọ nke plasmapheresis anọwo na-eji na US na nweela ewu ewu na USSR. Ma conclusiveness nke irè nke usoro adịghị ma elu-ezu, n'ihi na na-adakarị ọnwụnwa achọ ọtụtụ ọrụ afọ. Otú ọ dị, ndị ọkà mmụta sayensị na-lara ezumike nká na-aga n'ihu n'ọmụmụ plasmapheresis. Gịnị ya me ka a kpọrọ mmadụ? Ọkà mmụta sayensị eyịre nyere ọgwụ a zuru okè irè ụzọ hichaa ọbara. Ugbu mwepụ "mmeru" plasma a na-ewere a nnọọ irè usoro na ọtụtụ enweghị nchịkwa na-ekwu, nke na-ebu dị iche iche intoxications organism.

Olee ụdị na ụzọ adị plasmapheresis

E nwere atọ isi classifications nke plasmapheresis.

1. Site oru

Ọ bụrụ na ọbara ọcha bụ ọgwụgwọ na ọdịdị na a na-eji wepụ ihe ọ bụla ọrịa ma ọ bụ ọnọdụ, ọ bụ - ọgwụgwọ plasmapheresis. N'ihi ya ẹdụk ekara ọcha na-laghachi na onye ọrịa, na plasma na-anọchi enye onyinye ọbara ma ọ bụ a pụrụ iche ngwọta.

Ọ bụrụ na nkewa nke ọbara na-ekenịmde nweta plasma si ike onye maka inwekwu ojiji, dị a usoro a na-akpọ plasmapheresis-enye onyinye.

2. N'ụzọ

E nwere a pụrụ iche plasmapheresis na akpaka. Ke akpa idaha ọrịa emewo a bukwanu ego nke ọbara na-enịm ke a akpali mmasị akpa na nchekwa na omume plasma nkewa site centrifugation ma ọ bụ ọdịda. Mgbe onye ọrịa na-agbara intravenously fọdụrụ mgbe mwepụ nke cell uka nke plasma, jiriwo saline. Nke a na usoro a na-akpọ akwụkwọ ntuziaka.

Na akpaka plasmapheresis ọbara collection, filtration ma laghachi ya na akpa ẹkenịmde ke obere òkè site nkewa ngwaọrụ. Ọzọkwa, niile Filiks-ebe niile. Usoro a bụ ihe ọma n'ihi ọrịa bụ ihe ndị ọzọ mobile na-egbochi mmebi mkpụrụ ndụ, dị ka megide akwụkwọ ntuziaka.

3. Site wepụ usoro na a plasma nhazi

Dabere na Usoro nke mmiri mmiri òkè a na-ewepụ, plasmapheresis ekewa:

• The centrifuge.
• Akpụkpọ ahụ.
• Threaded.
• Sedimentation (bezapparatny plasmapheresis).
• Krioplazmaferez.

Onye ọ bụla usoro nwere ya uru na ọghọm. The kasị ewu ewu na-atụle ga-akpụkpọ ahụ plasmapheresis. Sedimentation usoro bụ fọrọ adịghị eji, ma ọ bụ ọtụtụ dị ọnụ ala karịa ndị ọzọ.

Description of usoro

The centrifuge usoro dabeere na iwu nke ike ndọda. The ngwaọrụ na-enye ọbara bugharia na elu na-agba, nke mere na ọ bụ iche na ya nweta. N'ihi ya ekara ọcha na-laghachi ahụ, na plasma wepụrụ. Usoro a bụ gharazie ịba uru, ọ nwere otutu contraindications, Ọzọkwa, na-abụkarị n'oge centrifugation cell mmerụ.

Akpụkpọ ahụ na usoro-agụnye iji ihe ndị ngwa onwem na pụrụ iche nzacha na pores nke ayakde plasma, kpụrụ ihe na-egbu oge. Nke a na Usoro nwere ya uru:

• Vol plasmafilters.
• Nchedo ọrịa.
• The rapidity nke usoro.
• Ole na ole na contraindications.
• The mkpụrụ ndụ na-abụghị mebiri emebi.
• Ekwe omume nke ngwa nke usoro maka ọgwụgwọ nke cancer ọrịa.

Threaded usoro e ji na na ọbara na-aga abụọ nhazi. Akpa, cell uka na iche na plasma na-ahụ ẹdụk site ọcha nnukwu ụmụ irighiri ihe, ndi na-edozi na lipids. Nke a na Usoro bụ na-ewu ewu na ọgwụgwọ nke atherosclerosis.

Bezapparatny plasmapheresis (ma ọ bụ sedimentation) a rụrụ na-enweghị iji ọ bụla pụrụ iche na ngwaọrụ. The ọbara iche n'ime abụọ n'ụzọ n'okpuru nduzi nke ike ndọda. Nke a bụ a dị nnọọ mfe na ọnụ plasmapheresis. Ya price bụ nnọọ iche na-eri nke ndị ọzọ ụzọ. Ma ọ dịghị ekwe hazie nnukwu mpịakọta nke ọbara.

Krioplazmaferez agụnye mwepụ nke plasma si ya na friji na -30 ^{° C,} sochiri Okpomoku 4 ^{° C} sochiri centrifugation. Part nke mmiri mmiri nke precipitated e wepụrụ, na ndị fọdụrụ plasma na-laghachiri azụ onye ọrịa ahụ.

The n'ahụ mmetụta nke usoro

plasmapheresis usoro na-enye ohere iji kpochapụ ihe ahu nke ihe mmapụta ngwaahịa nke metabolism (urea, creatinine, uric acid),-alụso ọrịa ọgụ, abụkwara, homonụ, macromolecular lipid ogbugbo nke mbufụt na ndị ọzọ na-emerụ bekee. Mwepụ nke wuru plasma eme hypovolemia na-akpalite compensatory na Nsonye nke ahụ dum ihe nchebe. Ke adianade do, ọmụmụ rushes si anụ ahụ n'ime arịa iweghachi ekesa ọbara olu. Nke a na-eduga ná a ọnụ ke ọkọ na ebelata nsí mmetụta nke pollutants awa ole na ole.

Otú ọ dị, otu ụbọchị, ego nke nsí n'ime ọbara na-weghachiri eweghachi ọzọ. Ya mere, ndị ọkachamara nwere ike ikwu na plasmapheresis N'ezie, e maka 3-4 nleta. Na nke ọ bụla larịị nke ọhụrụ usoro a kpochara, mbụ agbanye, mgbe ahụ, na-akpa ákwà, na mgbe ahụ cell. The rheological Njirimara nke ọbara na-agbanwe na a mma direction, iwepu oké viscosity, mụbara ọbara eruba na oxygen eruba akụkụ na anụ ahụ. A ana achi achi mma na izugbe ala nke organism, dịkwuo agbanwe ike, na-ewepu na-emerụ ogige mmenaanya mgbaàmà.

Otú ọ dị, n'ịdabere nanị na ọbara plasma mgbanwe adịghị mkpa, n'ihi na ọ bụ mgbe niile mkpa na-ebu a mbara ọgwụgwọ nke ọ bụla ọrịa, ihe dọkịta iwu.

Iji gosi na nke a usoro

Ugbu a, ọtụtụ ndị dọkịta ji nye iwu plasmapheresis. Gịnị bụ a usoro - kacha ọrịa na-adịghị ọbụna na-aghọta. Ma, mara n'okpuru ihe ọnọdụ dị mkpa na-ekweta na a na usoro ọgwụgwọ na-maa mkpa. Plasmapheresis - a ọcha nke ahụ ahụ, nke a na-akwadoro maka ọgwụgwọ nke fọrọ nke nta nile nke ụmụ mmadụ na akụkụ na usoro. Otú ọ dị, e nwere ọtụtụ ihe ndị pathologies nke plazmoobmenom ọgwụ bụ onye zuru gosiri. Nke a pụtara na odida nke usoro nwere ike ime ka ọnwụ nke onye ọrịa. Ọrịa ndị dị na-agụnye:

• sickle cell anaemia ;
• thrombocytosis na leukocytosis;
• erythroleukemia;
• porphyrin ọrịa;
• hypercholesterolemia (butere n'aka);
• Rufọs ọrịa;
• DIC;
• hyperviscous syndrome;
• myasthenia gravis;
• Guillain-Barre syndrome;
• egbu oge thrombocytopenia;
• mioglobinemiya;
• intravascular hemolysis;
• Goodpasture si syndrome ;
• Gasser si syndrome;
• thrombotic thrombocytopenic purpura;
• cryoglobulinemia;
• adịghị ala ala polyneuropathy;
• nsị nsi.

Ikwu-egosi maka plasmapheresis bụ:

• Pathology nke eriri afọ tract: ọnyá afọ, Crohn oria.
• Ọrịa obi: a ọnọdụ mgbe a nkụchi obi, myocarditis, rheumatism na na.
• Allergy: atopic deramatit, pollinosis na ndị ọzọ.
• Dermatological ọrịa: psoriasis, pemphigus, herpes, wdg
• gbasara akụrụ ọrịa: Glomerulonephritis, urinary tract ọrịa, na otú pụta.
• Ọrịa nke akụkụ okuku ume na usoro: ụkwara ume ọkụ, hemosiderosis.
• Imeju nsogbu: autoimmune ịba ọcha n'anya na ndị ọzọ.
• Septic nsogbu mgbe ịwa ahụ.
• Systemic vasculitis.
• Na-egbu egbu ọnya na oncology.
• Atherosclerosis.

Nso nso, gynecologists nye ndụmọdụ emefu plasmapheresis n'oge ime ma ọ bụrụ na nwaanyị na-enwe toxicosis, e Rhesus-agha ma ọ bụ fetoplacental insufficiency. Nke a ndepụta bụ nnọọ ogologo. Mgbe niile, e nwere ihe 200 ọrịa na nke nwere ike n'ụzọ gara nke ọma mee plasmapheresis. Contraindications maka usoro a ndị dịnụ.

Ònye ga-enye ndị dị otú ahụ a usoro

N'ihi na nke a usoro, e nwere ọtụtụ contraindications. Ma, ọ na-machibidoro kpam kpam na-ebu n'iru irreversible ọnya nke akụkụ, akwụsịbeghị agba ọbara, coagulation aghara na gastric ọnyá afọ.

Ọ bụghị na-atụ aro na ọbara ọcha mebiri nke n'afọ iri na ụma na obi ọnụego, mgbali surges, na-ebelata viscosity ọbara ịhụ nsọ, nnukwu na-efe efe, hypoproteinemia, anaemia na agadi ọrịa, ndị dị iche iche nke ujo, oké ọrịa imeju, "ọjọọ" veins.

Ọ na-eji abụ na plasmapheresis n'oge ime bụ emerụ nwa ahụ ahụ ike, ma na-adịbeghị anya nnyocha na-aghọ ma ọ bụghị. Kwesịrị ịdị, isiokwu nke usoro nditịm na-egosi na dị ka ntụziaka.

N'ihi ya, ụfọdụ nke ala egbochikwa iji plasmapheresis dị ka usoro nke ọgwụ. Contraindications kwesịrị inyocha site ịga dibịa, karịsịa ma ọ bụrụ na e nwere ihe ize ndụ nke na-arịa ọrịa ọrịa ahụ ike bụrụ na nke ọdịda nke usoro.

Olee otú ọgwụ

N'ihi plasmapheresis adịghị achọ ọzụzụ pụrụ iche. Abụkarị usoro a rụrụ n'ụzọ pụrụ iche mkpachapụ itieutom ma ọ bụ ozugbo na onye ọrịa ahụ ụlọ. Iji mee nke a, a ọrịa dabeere na a pụrụ iche n'ihe ndina na-ewe a ala ọnọdụ. Dabere na usoro, a pụrụ iche catheter (fleksulyu) ndinọ na otu ma ọ bụ abụọ aka. Ọtụtụ mgbe a na-eme iji a akwara na gbagọrọ agbagọ nke n'ikpere aka. Ọ bụrụ na onye ọrịa bụ ndị dị oké njọ ọnọdụ, ndị catheter na-etinye n'ime subclavian akwara. Na ọbara adịghị clot na thrombus kpụrụ, na mgbakwunye fleksulyu ndinọ heparin.

The usoro dịruru banyere 1-2 awa. Ọ na-adabere usoro na ego nke ọbara na-kpochara. N'oge niile manipulations onye ọrịa bụ mgbe n'okpuru nlekọta nke ndị ọrụ. Ọ tụrụ usu ọnụego, ọbara mgbali, respiration na ndenye maka oxygen ọkọnọ na arọ.

Apparatuses maka plasmapheresis bụ obere ma ọ bụ anyịnya. Nke mbụ bụ ihe ndị ọzọ ga-adaba adaba n'ihi na ha nwere ike gaa ebe ọ bụla n'ụlọ ọgwụ ma ọ bụ n'ụlọ onye ọrịa. The ngwaọrụ ewe ọbara portionwise na banyere 40 ml na a oge, ọcha ka ọ laghachi azụ site na catheter na ọzọ na-ewe ọbara. Ụfọdụ ngwaọrụ iji akpaka ochichi nke anticoagulants. Na otu nkeji, ndị plasmapheresis ngwa bụ ike hazie banyere 100 ml ọbara, ie. E. Per hour ike wepu banyere 800 ml nke ngafe ọmụmụ.

Ndị ọkachamara na-akwado na wepụ otu nnọkọ na-erughị otu ụzọ n'ụzọ anọ nke ekesa plasma. Dọkịta na-atụ anya nke a na ọnụ ọgụgụ na-adabere n'otu n'otu: arọ na ọbara olu (CBV).

Ọ maara na ndị plasma bụ 55% nke Bcc. Na iji chọpụta nke ikpeazụ ọnụ ọgụgụ, ọ dị mkpa iji mụbaa ịdị arọ ahụ site 75. Dị ka ihe atụ, a onye-erikpu 80 n'arọ n'otu oge ị chọrọ ka ihichapụ ndị na-esonụ ọnụ ọgụgụ nke plasma:

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

Ọ dị mkpa ime ihe niile otosịrị iru, na-eduzi plasmapheresis. Abamuru na Harms nke ọgwụgwọ usoro-adabere na ọtụtụ ihe, gụnyere izi ezi nke mgbawa.

Nwere ike plasmapheresis-afụ ụfụ?

Nso nso a, a oké ọnụ usoro a positioned dị ka a panacea niile nsogbu. Private clinics karịsịa arụsi ọrụ ike na-akwalite plasmapheresis. Abamuru na Harms nke usoro a bụ kpọmkwem dabere na professionalism nke dọkịta. Ma dị nnọọ ka ọ bụla ọzọ usoro ọgwụgwọ, ọ nwere ya mmetụta na ọghọm:

• Anaphylactic ujo.
• Allergy ka na-enye onyinye plasma na-anọchi ya a mmiri mmiri.
• Autoimmune ọrịa akụrụ ka a mmeghachi omume a plasma-enye onyinye.
• Ofufe Ọrịa si enye onyinye plasma.
• Mmepe nke sepsis esonụ Standardization of aseptic.
• Ọbara ọgbụgba (ma ọ bụrụ na e nwere nsogbu na clotting).
• Thrombosis (na bụghị itinye anticoagulants).
• dobe na ọbara mgbali.
• Mwepụ bụghị naanị nsí kamakwa nri ọnụ na plasma.
• Dips ọgụ.
• Metabolic aghara na ọnụ ọgụgụ nke ndị ọgwụ na ọbara.
• Ọgbụgbọ.
• Isi ọwụwa.

Nke a bụ a dị nnọọ oké njọ na mgbagwoju anya usoro, otú i kwesịrị ịkpachara anya na ị na-ahọrọ a saịtị n'ihi na ọgwụgwọ. Ọtụtụ nkeonwe n'ụlọ ọgwụ na-enye ndị ọrịa plasmapheresis. Olee ụdị oru nke ndị ọkachamara na-arụ ọrụ n'ebe ahụ, ma nke mkpebi na-usoro? All ya kwesịrị ịma tupu n'ikwere ọgwụgwọ, ka ọ ghara ịdaba n'aka nke na-agụghị akwụkwọ scams. Mgbe niile, ọ pụrụ iduga ọdachi dakwasịrị ha.

Gịnị pụta ga-atụ anya

Irè nke plasmapheresis gosipụtara na ikpe nke ọtụtụ ọrịa. Mgbe nile ofu mmetụta dị mma usoro ọbụna mgbe ikwu na-egosi. Otú ọ dị, ọ ga-ghọtara na monotherapy nwere ike ọ bụghị mgbe niile inyere ya aka. Ya mere, ọ dị mkpa na-a mbara ọgwụgwọ site ruru eru ọkachamara, enweghị ịdabere na-agwọ ọrịa si otu N'ezie nke wepụ plasma.

Iji nweta ezi ihe, ị ga-ijide n'aka nke àgwà na-elekọta ma na-ata a mbido ule iji gosi enweghị contraindications na ojiji nke ndị dị otú ahụ ọgwụgwọ usoro ndị dị otú dị ka plasmapheresis.

The price nke a usoro bụ ezi elu (4500-5500 ths. Ruble), na-enwe ndidi ga-mkpa karịa otu ma ọ bụ abụọ, na 3-4 sessions, ma ọ bụghị na ọgwụgwọ ga-eme ka ọ bụla uche. Nke a ga-atụle. Otú ọ dị, ọtụtụ clinics na-enye ego ma ọ bụrụ na oge nke N'ezie bụ ihe karịrị 5 sessions. Ọ ga-kwuru na a na usoro nwere ike ịbụ ọnụ ala, t. Iji. The ngwá na ihe ndị ugbu a nnọọ oké ọnụ. Ya mere adịghị atụkwasị obi na ụlọ ọgwụ ebe usoro a rụrụ na a nnọọ ala price.

Iji ichikota

Ee, nke a ọgwụgwọ na-ewute onye ọrịa ahụ n'akpa uwe, ma ọ bụ ọnụ ahịa ya. Improvement n'ozuzu ọnọdụ, Nsonye nke nchebe na compensatory ọrụ, normalisation nke rheological kwa ọbara, mwepụ nke mgbaàmà nke igbu egbu - nke a abụghị a zuru ndepụta nke nti mmetụta anyị na-atụle usoro na ahu.

Plasmapheresis bụ ụzọ ọhụrụ nke na-enyere ọtụtụ ndị ọrịa aka ịnagide ọrịa ha ma mee ka ọbara nke "plasma" merụrụ ahụ dị ọcha. A gosiputara usoro a na oke onu ogugu di iche iche na enweghi mkpesa. Mmezu nke plasmapheresis site n'enyemaka nke ndị ọkachamara ruru eru na idebe ntụziaka niile na-enye nsonaazụ dị mma maka ọgwụgwọ nke ọbụna ọrịa ndị kachasị dị egwu.