Plasma-substituting solutions

Plazmozameshchate solutions are divided into shock, detoxification, for parenteral protein nutrition and special purpose.
Antishock plazmozameshchate solutions. Poliglyukin - 6% solution depolimerizovannogo dextran, synthesized Leuconostoe mesenteroides (strain SF-4). The value of mol. mass (mol. weight) 50-60 thousand provides oderjanie in the blood within days 40% of the administered drug, while maintaining its ability to eliminate the erythrocytes stasis in capillaries. From all P. R. has the most pronounced for shock effect. And vnutriarterialno intravenously injected to 2000 ml pro dosi. When the hemoglobin level in a patient above 8 g% can be used without additional blood transfusion; at lower hemoglobin content definitely a blood transfusion, we must begin with transfusion poliglyukina because it is faster than blood, raises blood pressure.
Polivinilpirrolidon has mol. a lot of 30-40 thousand; 3,5% solutions - hemo-vinyl, Periton, kompensan. Considering the threat of deposits in the internal organs used a single dose of not more 1000 ml For anti-shock properties inferior poliglukine, but surpasses salt plazmozameshchate solutions.
Polivinol (polyvinylalcohol) on the properties and structure similar to polyvinylpyrrolidone. Used with shocks I-III degree in the form of 3.5% solution in the dose to 1000 ml intravenous and vnutriarterialno.
Salt P. R. as an independent means of a shock therapy rarely used because of the low efficiency; used in combination with the transfusion of blood or plasma. Often used to dehydration organism in doses up to 2000 ml per day drip. Apply the following salt plazmozameshchate solutions: zerocrossing " (NaCl - 7.5 g; КCl - 0.2 g; MgCl2- 0.1 g; NaH2PO4-0,052 g; Na2HPO4-0,476 g; glucose - 10 g; distilled water up to 1000 ml; after sterilization add 250 ml of human serum blood); salt infusion " (NaCl - 8 g; КCl - 0.2 g; СаCl2-0,25 g; MgCl2- 0.05 g; Na2CO3-0,8 g; NaH2PO4-0,138 g; distilled water up to 1000 ml; saturated with carbon dioxide to pH=6,0); isotonic solution of sodium chloride (NaCl (9 g; distilled water up to 1000 ml); AM-4 (filtered and sterilized by autoclaving water of the Black sea); blood fluid I. R. Petrov (NaCl - 15 g; КCl - 0.2 g; СаCl2- 0.1 g; distilled water up to 1000 ml; recommended to mix with the blood in proportion 900 ml per 100 ml of blood); salt P. R. liquid Petrova most effective due to additives of blood and high gipertoniceski.
Detoxification P. R. Polivinilpirrolidon № (PVP-N) has mol. mass 12600± 2700; 6% solutions - gemodez, Periton N, neocompsa. Due to the low mol. weight completely out of the body during the day. The mechanism of therapeutic action diverse: the binding of toxins in the blood, elimination from the tissues, mechanical cultivation of toxins and holding them through renal barrier, stimulation of the reticuloendothelial system, the elimination of stasis in capillaries and regionalone of red blood cells, improvement of function of kidneys and increases diuresis, removing the fetal organs and tissues. Administered intravenously at a speed of not more than 300 ml per hour (40-50 drops per minute); if you exceed this rate of administration may have difficulty breathing, tachycardia, drop in blood pressure which disappears with the slowing of the rate of infusion. Infusion PVP-N designate children in the amount of 7-10 ml per 1 kg of body weight for adults to 500 ml pro dosi indicated. Readings and other conditions of application of PVP-N - see the table.

Nosologic form of the disease Indications Terms transfusion (days of illness) Repeated transfusions Note
Burn disease Anuria, diarrhoea phenomenon 1-5 1-2 1-2-day sickness alternate with transfusion poliglyukina
Toxic forms of dysentery and dyspepsia Convulsions, cyanosis, interceptada picture ECG, respiratory disorders and hemodynamics, diarrhoea phenomenon Immediately 1-2 Repeated transfusions is determined by residual phenomena of intoxication
Foodborne diseases Hypotension, convulsions, diarrhoea phenomenon, lymphocytopenia " 1 At insufficiency of hemodynamic effect Supplement to transfusion poliglyukina
Postoperative and other post-traumatic conditions Anuria, the absence of peristalsis, vomiting, cyanosis, and hypotonia 2-5 2-3 During operations on the background of severe intoxication transfusion to produce up operations
Hemolytic disease of the newborn For prophylaxis of cerebral complications (to reduce hyperbilirubinemia) 1-8 3-8 In severe forms to start with exsanguination, replacing disposable blood PVP-N. Transfusions be made twice a day
Birth trauma of the fetus, fetal infection and toxaemia Cerebral symptoms, respiratory distress, cyanosis 1-5 2-5 Transfusion most shows with symptoms of swelling of the brain and intracranial hemorrhage
Sepsis Hectic fever, chills, sweats, oliguria, lymphocytopenia Any 1-2 Combined with transfusions erythrocyte mass
Nephropathy pregnant Congestion in the blood vessels of the eye bottom, oliguria, vomiting, increase in blood pressure Any 2-3 When reintroduced to strictly monitor the level of arterial pressure

Detoxication effect of protein hydrolysates (see) is of a secondary nature and due to improvement of protein metabolism.
Plazmozameshchate solutions for parenteral protein nutrition. BK-8 is made from the blood serum of cattle; the species specificity almost completely eliminated. Injected inkjet again in a dose of not more than 500 ml pro die. When exceeding the dosage may develop bleeding.
Protein hydrolysates - L-103, hydrolyzate of casein, aminoatil - have the same therapeutic effectiveness; used in all kinds of protein deficiency and the impossibility of power per os (operations on the esophagus, stomach, etc.,).
Daily dose for maintenance of nitrogen balance - 1500 - 2000 ml; to improve the assimilation of amino acids contained in hydrolysates add 150-200 ml of 4% solution of glucose. Injected subcutaneously, intravenously (slow - 20 to 60 drops per 1 min) or in the intestine through a tube.
When speeding the introduction appear a sense of heat, hyperemia person and shortness of breath, disappearing in a slowing of the rate of introduction.
Plazmozameshchate solutions for special purposes. Albumin human blood - 10 and 20% solution is used for treatment of acute liver failure (epidemic hepatitis, massive necrosis of the liver, etc.) intravenously at a dose of 500 ml per day, and hemolytic disease of newborns for binding of bilirubin.
Protein (izuchennye plazmozamenitel)- a 4.3-4.8% of stable human plasma proteins. Dosage is not limited. Except hemostatic properties that replaces the native plasma transfusion.
Fibrinogen is administered only intravenously in the form of 1% solution in Hypo - and fibrinoliticakih hemorrhage (PPH and so on). 2 g fibrinogen on hemostatic properties replace 1 l of fresh plasma. The average therapeutic dose of 4-6, Produced in a dry kind; to use dissolved in distilled water. Cm. also Blood fluid, Protivosokovh liquids.