eqstrakorporaluri membranuli oqsigenaciis,

hemosorbciisa da sxva eqstrakorporaluri detoqsikaciuri meTodebis gamoyeneba tuberkuloziT daavadebuli pacientebis

mkurnalobaSi

 

paata aladaSvili,  nikoloz gegeSiZe, vaxtang SarabiZe

 

 

tuberkulozisa da filtvis daavadebaTa erovnuli centri

 

 

     hemosorbciisa da eqstrakorporaluri membranuli oqsigenaciis (emo) meTodebi, rogorc eqstrakorporaluri mkurnalobis meTodebis erT-erTi saxe, didi xania gamoiyeneba pulmonologiaSi. bolo drois gamokvlevebma daadastura misi efeqtianoba sxvadasxva nozologiuri formebis mkurnalobaSi.

     tuberkuloziT daavadebul avadmyofebSi Cvens mier, detoqsikaciis am meTodebis gamoyenebam, migviyvana im daskvnamde, rom SemTxvevaTa 80%-Si xdeboda avadmyofTa  mdgomareobis SesamCnevi gaumjobeseba intoqsikaciis mkveTrad Semcirebis xarjze. winamdebare naSromi exeba Cvens mier kompleqsur mkurnalobaSi hemosorbciis da emo-s  CarTvis Sedegad miRebul daskvnebs.

   marTalia tuberkuloziT daavadebul avadmyofebze adrec xdeboda hemosorbciis gamoyeneba, magram amJamad, Cvens mier Catarebul meTods aseve Tan axlda detoqsikaciis sxva meTodTa SeuRleba, kerZod: 30%-Si movaxdineT helium-neonis lazeris seansis CarTva, veyrdnobodiT ra mis Tvisebas, moaxdinos organizmis saerTo araspecifiuri rezistentuli stimulireba, imunuri Zalebis gaZliereba. amaSi aseve xels gviwyobda misi analgeziuri, anTebsawinaaRmdego da hipikoagulaciuri efeqti, ramac minimumamde daiyvana heparinis xarjva. hemosorbciis da emo-s Sedegad  aRiniSneboda leikocitebis fagocituri aqtivobis momateba, rac saSualebas gvaZlevda mkveTrad gazrdiliyo sorbentze toqsinebis gamoyofa. lazeroTerapias vaxorcielebdiT aparat ALOK-1-is saSualebiT, Segvyavda ra ZiriTad, specialuri kaTeteriT lazeris 1,5mV intensivobis sxivi. lazeroTerapias vaxorcielebdiT 30 da 60-wT-iani saensebiT kviraSi 4-5-jer, SemdegSi 2 kviriani SesvenebiT, Semdgom pacientis mdgomareobis xelaxali registrirebiT_rentgenografia, sisxlis reologia, imunologiuri gamokvleva, bioqimiuri gamokvleva_kvlav vimeorebdiT seanss.

    SemTxvevaTa 40%-Si Cvens mier aseve gamoyenebuli iqna sisxlis ultraisferi dasxivebis meTodis SeuRleba hemosorbciasTan da emo-sTan. am SemTxvevaSi veyrdnobodiT ultraiisferi dasxivebis Sedegad T da B limfocitebis funqciuri aqtivobis momatebas, imunoglobulinebis koncentraciis normalizacias, organizmis araspecifiuri rezistentobis stimulacias. am manipulaciis warmoebisTvis viyenebdiT aparat ИЗОЛДА-s. dasxivebuli sisxlis raodenobas vsazRvravdiT wonisa da simaRlis saSualebiT. seanss vatarebdiT dReSi 1-jer xuTi dRis ganmavlobaSi. gameorebas vaxdendiT 2 kviriani intervaliT.

     Cvens mier Catarebuli detoqsikaciis Sedegebis registrireba xdeboda, PULMA-s aparatisa da metabolografis gamoyenebiT, etepobrivad vaxorcielebdiT rentgenologiul gamokvlevebs, imunur Seswavlas vaxorcielebdiT rogorc manipulaciamde, ise misi Catarebis Semdeg.

     hemosorbciis da emo-s kursi mimdinareobda SemuSavebuli meTodikis saSualebiT. avadmyofs manipulaciis wina dRes utardeboda heparinizacia, meTodisaTvis viyenebdiT aparat УАГ-0I-s. emo-s Casatareblad viyenebdiT FREZINUS-s tipis oqsigenatorebs, sorbentad ki vxmarobdiT naxevradgamtari membraniT dafaruli gaaqtivebuli naxSiris Semcvelobis sorbentebs CKN-1k da CKN-2k. sorbentTa momzadeba xdeboda, natriumqloridis 0,9%-iani xsnaris saSualebiT, romliTac irecxeboda 30 wuTis ganmavlobaSi, Semdeg xdeboda sorbentSi 10000 IU hepariniT gajerebuli Nacl 0.9%-iani - 400,0 ml xsnaris gatareba. sorbentis  amgvarad momzadeba saSualebas gvaZlevda,  minimumamde dagveyvana sisxlis formiani elementebis  travmireba, Tavisufali bilirubinisa da hemoglobinis momateba. konturs vkravdiT ZiriTadad vena_venuri Suntis saxiT. sorbentSi sisxlis vatarebdiT 80-dan 100-ml/wT siCqariT. gamosayenebeli heparinis dozas vsazRvravdiT koagulogramis saSualebiT, manipulaciis momentSi kvlav xdeboda sisxlis nakadSi heparinis dozimetriT Seyvana, raTa agvecilebina formiani elementebis tramvireba. pirogenuli reaqciis acilebis

 

mizniT xdeboda premedikaciis Catareba antihistaminuri da neiroleptiuri preparatebis saSualebiT.

      rogorc mogexsenebaT, tuberkulozis sxvadasxva formiT daavadebul avadmyofebs uviTardebaT endogenuri intoqsikacia, rac kidev ufro amZimebs daavadebis mimdinareobas. Cvens mier avadmyofTa SerCeva xdeboda maTi daavadebis klinikuri formisa da mimdinareobis xasiaTis mixedviT: cxelebis saxe, filtvis, gulis, filtv-gulis, RviZlisa da Tirkmlis ukmarisobis ganviTarebis sxvadasxva etapi. endotoqsikozi, gansakuTrebiT generalizebuli infeqciis dros iZleva polimorful simptomatikas: iwvevs hemodinamikis destabilizacias, hiperTermias, encefalopaTias, RviZlisa da Tirkmlis mwvave da, rac mTavaria, Cvens praqtikaSi (igulisxmeba ftiziatria) filtv-gulis mzardad mwvave ukmarisobebs, sisxlSi matulobs toqsiuri metabolitebi: Sardovana, kruatinini, antigen-antisxeulebis bmebi, aminoazotaza, narCeni azoti, glikemiis done, xdeba fermentebis momateba, matulobs AST, ALT, LDG tutovani fosfataza; aseve xdeba sisxlSi saSualo molekuluri oligopeptidebis momateba, uaresdeba sisxlis reologiuri maCveneblebi da a.S.

      rogorc zemoT ukve aRvniSneT, imunuri gamokvlevis araspecifikur reaqtiulobas vxsnidiT leikocitebis fatocituri aqtivobiT, fagocitebis raodenobis gansazRvriT, komplementis titris 100%-iani hemoliziT. imunur statuss vsazRvravdiT T da B limfocitebis SefardebiTi da absoluturi raodenobiT, limfocitebis doniT, aseve rogorc T, aseve B aqtiuri limfocitebis subpopulaciebiT. IgG, IgA, IgM cirkulirebadi imunokompleqsebis gansazRvriT. rogorc imunurma gamokvlevebma cxadhyo, tuberkulozis sxvadasxva formiT daavadebul avadmyofebs aReniSnebodaT imunuri statusis mkveTri Secvla-gauareseba.

      emo-s da hemosorbciis meTodis da masTan SeuRlebuli detoqsikaciis sxva meTodebis efeqturobas vsazRvravdiT rogorc klinikuri parametrebiT, aseve laboratoriuli testebiT. detoqsikaciuri efeqti aRiniSna yvela SemTxvevaSi, rac gamomJRavnda temperaturuli reaqciis SemcirebiT, Semcirda (da umetes SemTxvevaSi) moixsna encefalopaTiebi, gaumjobesda da SedarebiT stabiluri gaxda hemodinamika, moimata datvirtvis amtanobam, Semcirda bronqospazmi da misi intensivoba, miRebuli iqna xangrZlivi remisiebi; sagrZnoblad iklo medikamentebis xarjma, yovelive amasTan erTad gaumjobesda diurezi.

      hemosorbciis seansis Semdgomma laboratoriulma gamokvlevebma gvaCvena, rom sisxlSi Semcirda antigen-antisxeulebis bma, lekocituri intoqsikaciis indeqsi Semcirda 21,7%-mde, Sardovana Semcirda 30%-iT, kreatinini da Sardis mJava 40%-dan 50%-iT, narCeni azoti 30%-mde. pirveli dRidanve xdeboda eozinofilebis raodenobis Semcireba, limfocitebis donem moimata (17,02-dan 23-mde), meore dRidanve xdeboda aminotransferazebis donis Semcireba (1,86-dan 0.68-mde); moxda RviZlis funqciuri maCveneblebis normalizeba, gaumjobesda misi cilasinTezis funqcia, rac gamomJRavnda saerTo cilis donis momatebiT (68-dan 74,7g/l-mde). meore dRidanve iwyeba imunitetis maCveneblebis gaumjobeseba: imunoglobulinebi matulobs normamde. heptoglobulinis done iklebs.  aqve mogvyavs cxrili, romelSic naTlad Cans Tu rogor icvleba sunTqvis aparatis maCveneblebi.

monacemi

proceduris Catarebamde

Catarebis Semdeg

sunTqvis wuT-moculoba

0,5

10,8

ventilaciis eqvivalenti

39,1

42

sunTqvis koeficienti

0,7

0,68

sunTqvis sixSire

25

21

anatomiuri mkvdari sivrce

0,36

0,34

fiziologiuri mkvdari sivrce

0,35

0,4

gulis SekumSvis sixSire

85

88

 

      aqve mogvyavs avadmyofTa rentgenologiuri gamokvlevis Sedegebi, firebze naTlad Cans Tu rogor umjobesdeba bronquli xis suraTi da rogor ganicdis daavadeba ukuganviTarebas.

      Cvens mier Catarebuli emo  da detoqsikaciis meTodebi avavdmyofTa operaciuli mkurnalobas win uZRvoda 50 SemTxvevaSi. miviReT saintereso Sedegi:

1.        Cvens mier momzadebuli avadmyofebi ukeTesad itandnen operaciebs (90%).

2.       naklebad uviTardebodaT postoperaciuli garTulebebi (10%)

3.       garkveulwilad Semcirda specifikuri postoperaciuli recidivebi (10%).

4.       minimumamde iqna dayvanili maTi reabilitaciis dro; 

SeniSvna: 20 pacientze SeuZlebeli iyo maTi lazeroTerapiis, xolo 10 pacientze ultaraiisferi dasxivebis Catareba.  

      rogorc mogexsenebaT, tuberkuloziT daavadebul avadmyofTa postoperaciuli recidivebis ganviTareba, saerTaSoriso standartebiT, cvalebadobs 3%-dan 23%-mde Cvens mier gamoyenebuli detoqsokaciis meTodebis saSualebiT momzadebul avadmyofebs recidivi uviTardebodaT 4%-mde SemTxvevebSi, rac warmoadgens qveda zRvars. maTgan umetesobas warmoadgendnen is mamakacebi, romlebic uxeSad arRvevdnen eqimTa rCeva-darigebebs, Warbad Rebulobdnen alkohols da eweodnen Tambaqos.

      yovelive advilad asaxsnelia, vinaidan detoqsikaciis am meTodebis gamoyenebiT umjobesdeba organoTa sisxliT momarageba, sisxlis reologiis gaumjobesebisa da intoqsikaciis moxsnis xarjze.

      aqve mogvyavs Semdegi daskvna:

              I.      emo + hemosorbcia warmoadgens naklebtravmul proceduras, igi warmatebiT SeiZleba gamoyenebul iqnes tuberkulozis sxvadasxva formebis dros;

            II.      emo + hemosorbcia, lazeroTerapia da sisxlis ultraiisferi dasxiveba aumjobesebs, rogorc sisxlis reologias, aseve aumjobesebs organoTa perfuzias da maTi ujredebis JangbadiT gajerebas, riTac minimumamde dahyavs recidivebis ganviTarebis SesaZlebloba;

         III.      imunitetis da sisxlis formiani elementebis, gansakuTrebiT T da B limfocitebis zRvruli donis momateba xels uwyobs mkurnalobisTvis aucilebeli medikamentebis raodenobis da mkurnalobis xangrZlivobis Semcirebas;

 

 

 

 

 

gamoyenebuli literatura:

 

 

1.        C. nazarovi, i.belianini, s. postnovi.

filtvis tuberkuloziT daavadebul pacientTa hemosorbcia-problemebi 1989W. gv.-8g. 10-13.

2.       i. Simanko, a. torbinski.

generalirebuli Cirqovani infeqciebis dros endotoqsikozis koregireba aqtiuri meTodebiT. qirurgia 1990. 6, 50-56.

3.       o. kandievi, a. aleqseevi, s. novickaia, v. smirnova, a. Saxnazarovi.

qirurgiul endotoqsikozian avadmyofTa imunologiuri maCveneblebis dinamika sisxlis ultraiisferi sxivebiT moqmedebis fonze. qirurgia 1990  6. 88-91.

4.       i. svebura, b. rodionovi, e. lozevi. mizezebi, sixSire da profilaqtika filtvis tuberkulozis postoperaciul SemTxvevebSi.  - problemebi. 87.8,57,-60.

5.       o. luceviCi, v. petrovi, v.paukovi, s. bedoulovi, b. Spaliki.

paTogenetiuri aspeqtebi gavrcelebuli Cirqovani peritonitis mkurnalobaSi.

qirurgia 1990 7,  50-56.

6.       n. filipoviCi, v. kirkovski

apendikularuli genezis Cirqovani peritonitis kompleqsur mkurnalobaSi hemosorbciis gamoyeneba

qirurgia 1990 7.56-59.

7.       a docenko, v. grubniki, p. Sibulini

endoskopiuri lazeruli Careva filtvis kibos SemTxvevaSi

qirurgia 1990 II. 79,86.

8.       i.piksini, n. atiasovi, r. kisilova, m.ramanovi. l. dosofeeva, p.grugliakovi.

qirurgiaSi sisxlis ultraiisferi dasxiveba

qirurgia 1990 II, 100-104.

9.       i. neimarki, v. ovCinnikovi

detoqsikaciis eqstrakorporaluri meTodebis gamoyenebis gamocdileba muclis Rrus organoTa mwvave daavadebis dros.

qirurgiis macne 1991w. I. 86-89.

 

 

 

 

Summary

 

Usage of extra corporal membrane oxygenation, hemabsorbtion and

other extra corporal detoxic methods in treatment of patients infected with tuberculosis

 

P. Aladashvili, N. Gegeshidze, V. Sharabidze

 

National center of tuberculosis and lung diseases

 

 

 

 

The article deals with the usage of extra corporal membrane oxygenation, hemabsorbtion and other extra corporal detoxic methods in treatment of patients infected with tuberculosis. As a result of the research the following conclusions were made:

·        The above-mentioned method is a procedure which causes fewer traumas. It may be used with different forms of tuberculosis.

·        EMO+hemabsorbtion, lasotherapy and ultraviolet ray of blood improves both blood reology and perfusion of the bodies, and thus minimizes the possibility of recidiv development.

·        Increase of immunity and blood elements, especially T and B lymphocyte level, favors decrease of quantity of medicines as well as durance of treatment.