Infusion therapy in the internal diseases’ propaedeutics

V. Chernii
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Abstract

Background. Infusion therapy (IT) is one of the main methods of drug therapy optimization. The essence of IT is to correct homeostasis disorders in order to detoxify, to restore the disrupted microcirculation and tissue perfusion, to eliminate the disorders of rheological and coagulation blood properties, to eliminate metabolic disorders, to improve drug delivery to the pathological focus, to restore circulating blood volume, to normalize fluid and electrolyte and acid-base balance. Objective. To describe modern IT. Materials and methods. Analysis of the literature sources on this topic. Results and discussion. Requirements for modern plasma substitutes include safety, sufficient and long-lasting volemic effect, rapid renal excretion, lack of accumulation and effect on the coagulation system, maximum similarity to blood plasma, and availability. There are several classes of plasma substitutes, and each of them has its own indications. For example, crystalloids are prescribed for dehydration, and colloids – for hypovolemia. The infusion volume is calculated based on the physiological needs of the organism, taking into account pathological fluid loss (fever, shortness of breath, postoperative wound drainage, vomiting, polyuria). Endogenous intoxication (EI) – a pathological condition that occurs as a result of exposure to toxic substances of exogenous or endogenous nature, which cause dysfunction and the development of extreme conditions – is an important field of IT application. EI can accompany chronic heart failure, peripheral vessels atherosclerosis, autoimmune and allergic diseases. Toxins have a direct (direct destruction of proteins and lipids, blocking of synthetic and oxidative processes in the cell) and indirect (microcirculation system and vascular tone disorders, changes of blood rheological properties) adverse effects. Clinical manifestations of EI include fever, malaise, and the dysfunction of various internal organs. As EI depletes the natural mechanisms of detoxification, worsens the clinical course of the disease, reduces drug sensitivity, suppresses immunity, it is an indication to detoxification via infusion. The tasks of the latter are to improve tissue perfusion, to provide hemodilution with a decrease in the toxins’ concentration, to stimulate diuresis, to eliminate acidosis, and to maintain the functional state of hepatocytes. For this purpose, solutions of polyatomic alcohols (Reosorbilact, Xylate, “Yuria-Pharm”) can be used. Reosorbilact increases the circulating blood volume, improves microcirculation and rheological blood properties, increases tissue perfusion, promotes “wash-out” of toxins, corrects acidosis and fluid and electrolyte balance, normalizes hepatocyte function, improving the own detoxification mechanisms. In case of microcirculation disturbances, it is reasonable to use the combined IT with the inclusion of Reosorbilact, Latren and Tivortin (“Yuria-Pharm”). Latren increases the elasticity of erythrocytes, reduces the aggregation of erythrocytes and platelets, normalizes the electrolyte composition of blood plasma, and Tivortin acts as a substrate for the formation of nitric oxide – the main signaling molecule of the endothelium. In addition to EI, IT usage is often prescribed for diabetic ketoacidosis. In such cases, it is advisable to use Xylate (“Yuria-Pharm”), which has antiketogenic properties, improves hemodynamics, corrects acidosis, and does not increase blood glucose levels. Xylate is recommended to be used only after preliminary rehydration with the help of isotonic saline solutions. Conclusions. 1. IT is an important method of treating a number of diseases. 2. EI accompanies not only diseases that involve intoxication syndrome, but also almost all internal diseases. 3. Reosorbilact and Xylate are the optimal solutions for detoxification. 4. It is reasonable to use combined IT, for example, the combination of Reosorbilact with Latren and Tivortin.
输液治疗在内科疾病预防学中的应用
背景。输液治疗是优化药物治疗的主要方法之一。IT的本质是纠正体内平衡紊乱,以便解毒,恢复被破坏的微循环和组织灌注,消除血液流变学和凝血特性的紊乱,消除代谢紊乱,改善药物对病理病灶的输送,恢复循环血容量,使液体、电解质和酸碱平衡正常化。目标。描述现代IT。材料和方法。本课题的文献来源分析。结果和讨论。对现代血浆替代品的要求包括安全性、充分和持久的容血作用、快速的肾脏排泄、缺乏积聚和对凝血系统的影响、与血浆的最大相似性和可用性。血浆替代品有好几类,每一类都有自己的适应症。例如,晶体类药物用于脱水,胶体类药物用于低血容量。输液量是根据机体的生理需要计算的,同时考虑到病理性体液流失(发热、呼吸短促、术后伤口引流、呕吐、多尿)。内源性中毒(EI)是一种由于暴露于外源性或内源性有毒物质而导致功能障碍和极端情况发展的病理状态,是IT应用的一个重要领域。EI可伴随慢性心力衰竭、外周血管粥样硬化、自身免疫性疾病和过敏性疾病。毒素有直接的(直接破坏蛋白质和脂质,阻断细胞内的合成和氧化过程)和间接的(微循环系统和血管张力紊乱,血液流变学特性的改变)不利影响。EI的临床表现为发热、不适、脏腑功能紊乱。由于EI耗竭自然解毒机制,加重疾病临床病程,降低药物敏感性,抑制免疫,是输注解毒的指征。后者的任务是改善组织灌注,通过降低毒素浓度提供血液稀释,刺激利尿,消除酸中毒,维持肝细胞的功能状态。为此,可以使用多原子醇(Reosorbilact, Xylate,“Yuria-Pharm”)的溶液。Reosorbilact增加循环血容量,改善微循环和血液流变学特性,增加组织灌注,促进毒素的“冲洗”,纠正酸中毒和液体和电解质平衡,使肝细胞功能正常化,改善自身的解毒机制。在微循环紊乱的情况下,合理使用含Reosorbilact, Latren和Tivortin(“Yuria-Pharm”)的联合it。Latren增加红细胞的弹性,减少红细胞和血小板的聚集,使血浆电解质组成正常化,Tivortin作为一种底物形成一氧化氮-内皮细胞的主要信号分子。除EI外,糖尿病酮症酸中毒也常使用IT。在这种情况下,建议使用Xylate(“Yuria-Pharm”),它具有抗生酮特性,改善血液动力学,纠正酸中毒,并且不增加血糖水平。建议仅在等渗盐水溶液帮助下初步补液后使用木酸盐。结论:1。它是治疗许多疾病的重要方法。2. EI不仅伴随中毒综合征的疾病,而且几乎伴随所有的内科疾病。3.Reosorbilact和Xylate是解毒的最佳解决方案。4. 合理使用组合It,例如,Reosorbilact与Latren和Tivortin组合使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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