BLOOD-SUBSTITUTING LIQUIDS

From Big Medical Encyclopedia

BLOOD-SUBSTITUTING LIQUIDS (synonym: blood substitutes, plasma substitutes, blood-substituting solutions, plasma substituting solutions, haemo proofreaders) — the means applied with the medical purpose in quality of substitutes or proofreaders of blood. To. use for transfusion therapy at various patol, states; enter them intravenously, vnutriarterialno, vnutrikostno, sometimes subcutaneously or via the probe in went. - kish. path.

Blood (see) possesses extremely important and multilateral biol and to lay down. action and therefore it cannot be completely replaced by any others to lay down. means. The term «blood substitutes» arose because the developed drugs possess therapeutic action, very effective, comparable to blood.

Originally scientific researches were directed to receiving and use of salt solutions of various structure — simple and combined. In 1869 I. R. Tarkhanov in Russia and A. Cohnheim in Germany established that at blood loss intravenous administration of isotonic solution of sodium chloride has favorable hemodynamic effect. However isotonic solution of sodium chloride does not possess necessary: a set of electrolytes for maintenance of constancy of ionic composition of plasma. Compoundings of complex salt solutions into which structure a number of the salts which are available in a blood plasma is entered (Ringer's solutions, Ringera — Locke, Hartman, laktasol, etc.) were developed for elimination of this shortcoming; these solutions received the name ekvilibrirovanny, i.e. balanced. Salt solutions apply at the circulator disturbances which are followed by deficit of extracellular liquid (dehydration). At heavy blood loss and shock salt solutions are a little effective since they quickly leave a blood channel therefore it is recommended to use them in combination with blood or plasma after removal of the patient from serious condition and improvement of hemodynamic indicators.

In the period of the Great Patriotic War (1941 — 1945) in a wedge, practice applied salt solutions, to the Crimea added 10% of whole blood (Petrov's liquid) or 20% of blood serum — serotransfuzin TsIPK.

Attempts to receive To were made. from heterogeneous protein by impact on blood serum of animals various physical. and chemical factors. A number of drugs as abroad — Edwards (1943) serum is made, and in the Soviet Union — to lay down. Belenky's serum (LSB, 1945), drug BK-8 (1955). Some of these drugs rendered positive effect at treatment of shock and at proteinaceous insufficiency. However creation of such drugs from heteroprotein is connected with great difficulties. Processing of heteroprotein for removal of anaphylactogenic properties quite often involves change its pier. weight that reduces hemodynamic effect of protein, and sometimes leads to delay of a blood coagulation. Often found residual anafilaktogennost and a non-standard of heteroproteinaceous solutions formed the basis for failure from their use in to lay down. to practice.

Short duration of therapeutic effect of salt blood-substituting solutions and difficulty of receiving not anaphylactogenic blood substitute on the basis of heterogeneous protein caused expediency of development of other blood-substituting solutions. For this purpose used a number of high-molecular substances (arabic gum, pectin, to gelatin, polyvinylpirrolidone, a dextran, etc.). To., the containing arabic gum and pectin, though rendered positive effect at treatment shock (see) and acute blood losses (see), but in connection with cumulative properties did not gain distribution. Creation of synthetic blood substitutes on the basis of polymers of a dextran and polyvinylpirrolidone is of great importance for development of transfusiology.

Wedge, transfusiology (see) has a considerable set of the infusional environments possessing various fiziol, an orientation. The characteristic of the main is very important to lay down. properties of each blood-substituting solution. There are many classifications To., which cornerstone sources of receiving, physical are. - chemical properties of drugs, the mechanism of their action, etc.

Earlier it was accepted to divide blood substitutes into two groups depending on their structure and physical. - chemical characteristics of solution: crystalloid and salt; colloid and proteinaceous and synthetic. A. N. Filatov and I. R. Petrov (1958) allocated three groups K.: salt — crystalloid solutions; solutions with components of human blood; solutions with the colloids alien to an organism (solutions from the processed heterogeneous protein and synthetic colloids). A. N. Filatov and F. V. Ballyuzek (1972) made some additions to this classification, but the principle of division of blood substitutes into crystalloids and colloids remained.

In Central research in-those hematology and hemotransfusion A. A. Bagdasarov, P. S. Vasilyev, D. M. Grozdov (1958) offered classification of blood substitutes by the functional principle. According to this classification blood substitutes were divided into three groups: hemodynamic; disintoxication; drugs for parenteral food.

The most frequent indications to to hemotransfusion (see) blood loss and shock of various origin, intoxication of an organism and disturbance of protein metabolism, an acid-base, electrolytic and water balance is, In this regard a number of the drugs capable to perform the most important functions of blood was developed.

O. K. Gavrilov (1976) suggested to consider blood substitutes and as haemo proofreaders since they carry out correction of composition of blood at various patol, states. At the same time to lay down. properties K. the directed action not only is not conceded on properties to a blood plasma, but often are more effective.

In a number of the countries great interest is shown to the blood substitutes-haemo-proofreaders modeling respiratory functions of blood — to carriers of blood gases.

Except blood substitutes of the directed action, the solutions combining various are developed to lay down. properties of blood — complex multifunctional blood substitutes.

The applied blood substitutes the pas is reasonable to divide six groups (tab. 1): 1) hemodynamic (antishock) — for treatment of shock of various origin and normalization of disturbances of a hemodynamics, including microcirculation, for hemodilution (see. Antishock liquids ); 2) disintoxication — for treatment of intoxications of various etiology; 3) drugs for parenteral food (see. Parenteral food ); 4) regulators water-salt and acid-base equilibrium — various salt solutions and osmodiuretichesky substances which also carry out correction of composition of blood; 5) blood substitutes with function of transfer of oxygen; 6) multifunctional blood substitutes of complex action.

Classification of blood substitutes on funkts. to a sign allows clinical physicians to make in each case the directed choice of solutions and by that to receive higher to lay down. effect.

Along with use of separate blood substitutes of the directed action in some cases their complex use (perfused cocktails) is recommended.

The majority To. is issued the industry that expands possibilities of their use to lay down.; institutions.

Requirements to To. it is necessary to divide into the general — for all groups and private — for this group. General requirements: To. shall be brought completely out of an organism, without damaging fabrics and without breaking function of bodies, or to be metabolized by fermental systems; their physical. - chemical properties shall be constant; drugs shall not cause a sensitization of an organism at repeated introductions; they shall be non-toxic, depyrogenized, sterile; shall have ability to remain for a long time without change of the properties.

Requirements to separate groups K. are various. So, e.g., antishock blood substitutes shall possess defined a pier. it is powerful (weight) for ensuring rather long circulation in circulatory system.

Krovezamenyayushchy solutions of disintoxication action

Krovezamenyayushchy solutions of disintoxication action shall have rather low pier. the weight of polymer that he was quickly brought from an organism, promoting removal of toxic products. The main requirement to the blood-substituting solutions intended for parenteral food — active inclusion in a metabolism and recovery of the proteinaceous and energy balance of an organism.

To a nek-eye to drugs the main requirements are ability to normalize water-salt and acid-base equilibrium of blood; to transport oxygen; to possess multifunctional action.

Blood substitutes of hemodynamic (antishock) action

Blood substitutes of hemodynamic (antishock) action shall keep a long time in a blood channel, recover blood pressure, carry out a role of plasma proteins on maintenance of colloid osmotic pressure and then be brought gradually out of an organism. For receiving antishock To. use dextran (see) and to gelatin (see).

A dextran — polymer of glucose; it is received by biol, synthesis, using culture of Leuconostoc mesenteroides on the Wednesday containing sucrose. At the same time the so-called native dextran about a pier is formed. weighing hundreds millions. For reduction a pier. weight and allocation of fraction with certain properties the native dextran is subjected to acid hydrolysis and fractionation.

The mechanism of splitting of a dextran in an organism was found out thanks to works E. L. Rosenfeld (1955 — 1956), A.S. Saenko (1963 — 1964), Ammona (R. Ammon, 1963), the animals who found in bodies and the person the enzyme splitting a dextran.

For the first time the blood substitute on the basis of a dextran (Macrodexum) was offered in Sweden in 1943 by Gryonvallem and Ingelmann (A. Gronwall, V. to Ingelmann). Wedge, tests of drug showed its high to lay down. action.

In the Soviet Union from antishock blood substitutes drug of a middlemolecular dextran about a pier is widely used. weighing 60 Ltd companies (+10 Ltd companies) — Polyglucinum developed by G. Ya. Rosenberg, T. V. Polushina, etc. (1954). The pilot studies conducted by N. A. Fedorov and V. B. Koziner (1956, 1974) showed that jet injection of Polyglucinum to fatally bloodless dogs quickly and with firmness recovers the ABP and breath. Efficiency of hemodynamic action of Polyglucinum is caused by its high colloid osmotic property and ability is long to circulate in a blood channel. A wedge, researches allowed to give appreciation to Polyglucinum applied at acute circulator disorders. The main indications to use of drug are traumatic, operational and burn shock, acute blood loss.

Domestic drug of a low-molecular dextran (average pier. weight apprx. 40 000) — reopoliglyukin, developed by T. V. Polushina, G. Ya. Rosenberg and K. I. Struchkova (1967), is an analog of the Swedish drug reomakrodeks. Drug is used at disturbance of a capillary blood-groove, for prevention operational and treatments of traumatic and burn shock; at disturbance of arterial and venous circulation, for prevention and treatment of thromboses and thrombophlebitises, an endarteritis, a Raynaud's disease; at heart operations with use of the cardiopulmonary bypass (it is added to perfused liquid); in vascular and plastic surgery; for desintoxication at burns, peritonitis, pancreatitis and so forth. Drugs of a low-molecular dextran support the volume of the circulating blood more quickly, than drugs of a middlemolecular dextran that is connected with bystry disappearance of polymer from a blood channel. So, in 6 hours after infusion the content of drug in blood decreases approximately twice; for this period with urine 60% of drug, and in 24 hours — 70-80% are removed.

Other antishock blood substitutes on the action concede to Polyglucinum. Positive assessment drugs received the gelatin remaining in liquid state at the room temperature: plazmazhel (France), gemozhel (Germany) and domestic drug Gelatinolum (average pier. weight 20 000), developed by L. G. Bogomolova and T. V. Znamenskaya (1962). Gelatinolum is applied at treatment of hemorrhagic, operational and traumatic shock of the I—II degree, during the training of patients for operation, for the purpose of desintoxication at burns, to filling of the cardiopulmonary bypass at gemodilyutsionny perfusions. The drug is administered intravenously or vnutriarterialno. The dose depends on a condition of the patient, can be at the same time entered by from 250 to 2000 ml. In more hard cases its use is combined with transfusions of blood.

Drug is produced in bottles on 250 and 500 ml, stored at a temperature not over 22 °.

The blood substitutes of disintoxication action applied to desintoxication of an organism shall connect and perhaps quickly remove toxicants. For receiving disintoxication blood substitutes use the polymers capable to connect to various substances. Carry to them polyvinylpirrolidone (see) and polyvinyl alcohol.

Polyvinylpirrolidone (PVP) connects and promotes removal from an organism of various dyes (congo red, eosine, methylene blue, etc.), even such which independently are not removed, and also snake poison, toxins of causative agents of diphtheria, dysentery, tetanus, etc. With reduction a pier. weight the speed of removal of PVP together with the connected toxic connections increases. Its successful use for desintoxication at infections, burns, gnoynoseptichesky processes, etc. is based on this property Since PVP is not split by fermental systems of an organism, blood substitutes on its basis do not contain high-polymeric fractions which are late the renal filter and are postponed in fabrics. Drugs on its basis have an average pier. weight 12 600 ± 2700. They found broad application at toxic forms acute went. - kish. diseases (dysentery, dyspepsia, salmonelloses, etc.), especially at children; at a burn and acute radial illness in a phase of intoxication; at a hemolitic disease of newborns; at peritonitises and impassability of intestines as means of temporary relief of a condition of the patient before operation and as means of desintoxication in the postoperative period; at an acute renal failure; at the hypostases caused hron, diseases of kidneys or toxicosis of pregnant women; at thyrotoxicoses; at sepsis; at various diseases of a liver (hepatitises, gepatokholangita, acute and subacute dystrophies of a liver, a hepatic coma).

Widely use domestic drug of low-molecular polyvinylpirrolidone — Haemodesum. Similar drugs under the name, etc. produce periston N, Neocompensanum abroad.

The mechanism of action of Haemodesum is based on its ability to connect toxins or decomposition products in the form of complex connections which are quickly brought out of an organism.

Lech. efficiency of Haemodesum is caused also by improvement of microcirculation, elimination of a staz of erythrocytes in capillaries and precapillary network that leads to improvement of a renal blood-groove and sharp increase in a diuresis. Disintoxication properties of drug at intoxications of various origin are much higher, than donor plasma.

Haemodesum, as well as other drugs on the basis of PVP, enter intravenously kapelno with a speed of 40 — 80 thaws of 1 min. The dose depends on age of the patient and degree of intoxication: for children of chest age — 5 — 10 ml on 1 kg of weight, the maximum dose — 70 ml, for children from 2 to 5 years — 100 ml, from 5 to 10 years — 150 ml, from 10 to 15 years — 200 ml] for adults the maximum dose — 400 ml.

The main quantity of Haemodesum is removed during the first 3 — 12 hours, almost completely — within a day.

Drug is contraindicated at the expressed cardiopulmonary insufficiency, at heavy allergies and a hematencephalon. Produce drug in bottles with a capacity of 100, 200, 400 ml. Store at a temperature from 0 to 20 °.

Carry solution of low-molecular polyvinyl alcohol to the same group of blood substitutes — Polydesum about a pier. weighing 10 000 +-2000, developed 3. A. Chaplygina, L. G. Mikhaylova, N. V. Shostakov (1968).

Drug is used at treatment of intoxications of various origin at surgical and infectious patients, at septic states in an obstetric ginekol, practice. After introduction the content of drug in a blood channel decreases by 23% in 3 hours; in 24 hours there are 25 — 40% of the entered quantity; traces of polymer find within 5 days. With urine 60 — 75% of Polydesum during the 24th are removed hour. With use gistokhy, methods polymer was found in bodies and fabrics during 3 — 7 days after introduction. Storage at a temperature not lower than 10 °. Freezing of drug is not allowed.

Blood substitutes for parenteral food

the Problem of parenteral food — a problem of maintenance in an organism of metabolic processes by direct introduction to blood of products of final enteral splitting of nutrients. With this way processes of biosynthesis of proteinaceous structures with all the specifics shall be provided. Parenteral food gains the increasing value.

Indications for use of drugs of parenteral proteinaceous food are all diseases which are followed by a hypoproteinemia of various origin when patients cannot eat food orally and also at a preparation for surgery of the weakened patients, in the postoperative period for normalization of a nitrogen metabolism, especially after surgical interventions on a gullet, went. - kish. a path and at maxillofacial operations, extensive burns.

The Soviet Union applies in to lay down. to practice three types of protein hydrolyzates: the hydrolyzate of casein developed by P. S. Vasilyev, H. A. Fedorov, N. S. Aleksandrovska, V. V. Suzdaleva, etc. (1954); hydrolyzates from blood proteins of cattle: Hydrolysinum developed by I. R. Petrov, L. G. Bogomolova and 3. A. Chaplygina (1954), and Aminopeptidum (see), developed by P.E. Kalmykov and T. I. Golubev (1956). The first two drugs receive by acid hydrolysis, the third — by means of enzymic hydrolysis (see. Hydrolyzates ).

From the protein hydrolyzates produced abroad gained the greatest distribution the aminoevils (Sweden). Protein hydrolyzates contain cleavage products of protein — amino acids and short peptides. All irreplaceable and replaceable amino acids, and also salts which are a part of a blood plasma are their part. They are completely deprived of anaphylactogenic properties.

Comprehensibility of protein hydrolyzates considerably increases at addition of vitamins of group B, especially B12 vitamin, and also hypertensive solutions of glucose and anabolic hormones.

Hydrolyzates enter intravenously, subcutaneously or via the probe in went. - kish. path. Transfusion is made only in the drop way. It is recommended to begin with 20 — 25 drops and at good tolerance gradually to increase to 40 — 50 drops in 1 min. A daily dose — 1,5 — 2 l. Drugs should not be used at cardiovascular insufficiency, a hematencephalon, acute nephrite and a nephrosclerosis, and also at a disease of veins (thrombophlebitis).

Hydrolyzates produce 400 or 450 ml in bottles. The hydrolyzate of casein is stored at a temperature from — 10 to 23 °; freezing of drug is not a contraindication to use on condition of preservation of tightness of packaging. Hydrolysinum is stored at a temperature from 4 to 20 °, Aminopeptidum — at a tekhmperatura from 1 to 20 °.

The balanced amino-acid mixes which composition included only free L-amino acids find application as drugs for parenteral proteinaceous food. They have considerable advantages before other drugs since may contain large amounts of free amino acids and can be rationally balanced in optimum ratios for synthesis of protein in an organism. These mixes shall contain all irreplaceable amino acids and some especially valuable replaceable. It is necessary to aim at such ratio of amino acids, a cut is optimum for satisfaction plastic and funkts, requirements of an organism; it is reasonable to consider also features patol, conditions of an organism.

Various amino-acid mixes are applied: S-2 moriamin (Japan), aminofuzin, aminoplasmal (Germany), freamin (USA), vamin (Sweden), etc.

On the basis of domestic amino acids drug the polyamine representing infusion solution with all irreplaceable amino acids and addition of some especially valuable replaceable amino acids is developed. As power substance hexatomic alcohol — sorbite enters. Good tolerance and high performance of drug how to lay down is established. means of parenteral proteinaceous food.

Amino-acid mixes enter by intravenously drop method with a speed of 25 — 35 thaws of 1 min. in doses 400 — 1200 ml daily for the entire period of an exception of oral food (5 — 10 days), further — depending on degree of manifestation of a hypoproteinemia.

For the greatest assimilation use of amino-acid mixes should be combined with introduction of various power components — carbohydrates (glucose, fructose), polyatomic alcohol (sorbite), the fatty emulsions promoting satisfaction of power requests of an organism, and also stimulators of protein metabolism — vitamins and hormones.

Regulators water-salt and acid-base equilibrium

Deviations in water and electrolytic balance exert negative impact on an outcome of traumatic and burn shock. In these cases it is necessary to apply rational compoundings of electrolytic solutions. To be limited to use of one electrolytic solutions it is admissible only in mild cases of burn and traumatic shock when the injury was not complicated by considerable blood loss. At more serious depressed cases transfusion of electrolytic solutions should be combined with more effective transfusion remedies (blood, plasma, Polyglucinum, etc.).

At various patol, states apply salt infusional solutions. Well proved drug laktasol, developed by G. Ya. Rosenberg and I. L. Smirnova (1975), close on composition of salt in solution to Ringer's solution, in addition containing milk to - that. It with success is applied to correction of a hemodynamics and acid-base equilibrium of blood.

The important role in correction of composition of blood at various patol, states belongs also to osmodiuretika, to the Crimea carry solutions of polyatomic alcohol — Mannitolum (see. Mannitol ) and sorbitol.

Salt solutions apply intravenously, subcutaneously, rektalno, struyno and kapelno. At traumatic and burn shock of heavy degree salt solutions are recommended to be applied in combination with blood, Polyglucinum, plasma, a protein after removal of the patient from a condition of heavy hemodynamic crisis. The dose of drug at the combined treatment is established individually, but it shall be not less than 1 — 2 l. At little traumatic shock and burns which area does not exceed 10 — 15% of a body surface use of one salt solution in a dose to 3 l is admissible. At acute circulator disorders as a result of heavy it is purulent - surgical complications (peritonitis, pancreatitis, sepsis), intestinal impassability, paresis of intestines, food toxicoinfection, coloenterites, dysentery the drug is administered in a dose 1-3 d in days and repeatedly within several days depending on a condition of the patient.

Use of salt solutions is contraindicated at a dekompensirovanny alkalosis and in all cases when introduction to an organism of large amounts of liquid is not shown (at the closed injury of a skull, a decompensation of cordial activity, a fluid lungs, etc.).

Drugs produce 400 ml in bottles, store at the room temperature. Freezing is not a contraindication to use on condition of preservation of tightness of packaging.

Blood substitutes with function of transfer of oxygen

in a number of the countries (the USSR, the USA) studies a possibility of use for intravenous administration as a blood substitute of drugs of the purified hemoglobin for improvement of respiratory processes in an organism of the patient. They are trained by method of cleaning of a hemolysate of erythrocytes of the remains of stromas and pro-coagulants of proteins. The received purified hemoglobin in an experiment is entered an animal in significant amounts — to 3 g on 1 kg of body weight.

L. G. Bogomolova and T. V. Znamenskaya (1975) developed drug of 3% of hemoglobin — erigy which renders positive hemodynamic, haemo static and erythropoietic effect at intravenous administration by the patient.

The new method of full cleaning of a hemolysate of erythrocytes of stromal proteins and procoagulant activity is developed by G. Ya. Rosenberg with sotr. (1975).

Blood substitutes of complex action

At serious depressed cases in parallel with frustration of a hemodynamics in an organism of the patient arise disturbances of microcirculation, a heavy tissue acidosis and accumulation of metabolites of exchange. In this regard new complex antishock blood substitutes for the purpose of increase are developed to lay down. actions of the existing blood substitutes of the directed action — Polyglucinum and a reopoliglyukin. On their basis also other complex blood substitutes of multifunctional action are developed: with salts of iron — for strengthening of an erythrogenesis (polifer); in combination with Mannitolum — for strengthening of diuretic and rheological action of a reopoliglyukin (glyukoman).

Special complex transfusion means — so-called perfused cocktails are developed for correction of disturbances of composition of blood, optimization of qualitative and its quantitative characteristics at various patol, states. They combine transfuziol. and pharmakol, activity. As a rule, all cocktails cause hemodilutions). A part of perfused cocktails use for partial perfusion of the isolated body parts and maintenance of their life activity or therapy by big concentration pharmakol, funds for the period of switching off from the general blood-groove.

Classification, chemical structure and purpose of the most widespread perfused cocktails are presented in table 2.

Cardiac perfused cocktail is intended for carrying out managed hemodilutions (see) during surgical interventions on open heart using the cardiopulmonary bypass. Gelatinolum, salt components, a source of reserve alkalinity, inhibitor of activation of a fibrinolysis, active anti-aggregation agents, stimulators of a myocardium, osmotic diuretics are a part of cocktail.

Apply the special solution offered by A. A. Vishnevsky to the isolated perfusion of coronary arteries of heart. This solution before perfusion of coronary arteries of heart is previously cooled to t ° 0 — 4 ° thanks to what in 2 — 6 min. it is possible to cool heart to t ° 36 — 12 — 8 °. The consumption of solution makes 400 — 900 ml.

Nefrol, cocktail is created for filling of the devices «artificial kidney», and also for auxiliary perfusions at patients with diseases of kidneys. Its structure included solution of albumine, anaboliziruyushchy means, acceptors of hydrogen ions, fosforilirovanny carbohydrates, salt components.

Antishock cocktail is applied in cases of catastrophic insufficiency of a hemodynamics and an acute fabric hypoxia (a cardiac standstill, asphyxia etc.). In structure of cocktail in quality transfuziol. bases enter solutions of dextrans. Pharmakol, activity is provided by specific anti-hypoxemic drugs, the active bases, and also the substances normalizing sokratitelny function of a myocardium.

Cocktail for partial perfusion of the isolated sites of an organism contains in quality of a basis a low-molecular dextran (reopoliglyukin), novocaine, anticoagulant of direct action, activators of a fibrinolysis. In this solution depending on the purpose of introduction and character patol. process include antishock drugs, antibiotics and other anti-inflammatory drugs.

The preserving cocktail is intended for perfusion of the isolated bodies for the purpose of their preservation. The basis of solution is made by albumine or colloid substitutes of plasma. Salt components, anti-hypoxemic drugs, energetically active agents enter its active part.

Antishock and disintoxication cocktails in quality transfuziol. bases have usual salt isoionic (on a blood plasma) solutions, colloid solutions or albumine. From the existing colloid solutions use Haemodesum, Polydesum, Polyglucinum, reopoliglyukin, Gelatinolum. Pharmakol, activity of cocktail is created at the expense of anesthetics, sedative, diuretic, anti-coagulative, power, spasmolytic and other means.

Artificial blood — the blood-substituting solution modeling the main most important functions of blood: filling of blood vessels (hemodynamics), transport of oxygen (respiratory function), delivery to fabrics of nutrients (amino acids, fats, carbohydrates, vitamins), providing water-salt and acid-base equilibrium, removal of products of metabolism.

The scientific research for the purpose of creation of artificial blood begun in the 60th 20 century did not go beyond laboratories and a frame of experiments on animals.

In a solution of the problem of creation of artificial blood the leading role is played by development of methods of receiving the transfusion components capable to provide performance of functions of erythrocytes on transfer of oxygen from lungs to fabrics in the conditions of full or partial desalination of an organism. Compoundings of complex multifunctional blood substitutes on the basis of widely known solutions like a dextran, Haemodesum, amino-acid mixes, a laktasola, and also the first models of blood substitutes — oxygen carriers, the containing emulsions of connections like fluorocarbons, chemically modified molecules of hemoglobin, inner-complex compounds of iron, artificial erythrocytes are developed.

Emulsions of fluorocarbons and the solutions of chemically modified haemo globins entered into a vascular bed allow to support life of bloodless animals within several hours.

Blood-substituting liquids in field conditions

the Role To. in field conditions it is extremely big. It is connected with a certain deficit of stored blood, and also with the fact that at a stage of the first medical assistance transfusion is more available To. Besides, the earlier intravenous administration of modern blood substitutes at traumatic, burn shock, massive blood loss, intoxication is begun, the result of the treatment struck will be better.

For field conditions long safety of blood-substituting solutions, an opportunity their instant just before introduction has important value.

In field conditions are most perspective isotonic solution of sodium chloride, laktasol, Polyglucinum, reopoliglyukin, Haemodesum, Gelatinolum, etc.

Tables

Table 1. CLASSIFICATION of the BLOOD-SUBSTITUTING LIQUIDS APPLIED In the USSR And ABROAD (P. S. Vasilyev, O. K. Gavrilov)



Table 2. CLASSIFICATION, STRUCTURE AND PURPOSE of PERFUSED COCKTAILS




Bibliography: Bagdasarov A. A., Vasilyev P. S. and Fromm A. A. Questions of classification of blood substitutes, Vestn. USSR Academy of Medical Sciences, 'JVe 4, page 58, 1958; Vasilyev P. S. and r about z d about in D. M. Functional classification of blood substitutes and its clinical justification, Works of the 12th Mezhdunarodn. kongr. on a modulation, blood, page 220, M., 1972; Vasilyev P. S. and From bonds of a dalev of V. V. Current state of a problem of parenteral proteinaceous food, Probl, gematol, and modulation, blood, t. 18, No. 7, page 3, 1973, bibliogr.; Gavrilov O. K. Development of transfusiology and the main achievements of service of USSR blood, in book: Probl, gematol, and transfuziol., under the editorship of O. K. Gavrilov, t. 1, page 24, M., 1976; Of l and N of c R. M. Rol of disturbances of metabolism in comprehensibility of nitrogenous substances at parenteral food and use of regulators of a metabolism for strengthening of their comprehensibility, in book: Ways of correction of metabolic frustration in the emergency and planned surgery, under the editorship of B. D. Komarov, page 15, M., 1976; Grozdovd. M. Znacheniye of use of protein hydrolyzates in clinic, Probl, gematol, and a modulation, blood, t. 18, No. 7, page 9, 1973; Blood substitutes, under the editorship of A. N. Filatov, L., 1975, bibliogr.; Blood substitutes and infusional environments in clinical practice, under the editorship of V. N. Shabalin, L., 1977, bibliogr.; Polyatomic alcohol and their use in transfusiology, under the editorship of A. N. Filatov, L., 1977, bibliogr.; Rosenberg G. Ya., Vasilyev P. S. and Grozdov D. M. Current state of a problem of blood substitutes and blood preparations, Owls. medical, No. 9, page 15, 1975; Fedorov N. A. and d river. Current state and perspectives of development of a problem of blood substitutes, Probl, gematol, and modulation, blood, t. 20, No. 11, page 16, 1975; G of p-w and 1 1 And. and. I ngelman V. of Dextran as a substitute for plasma, Nature (Lond.), y. 155, p. 45, 1945; R e p p e W. Polyvinyl-pyrrolidon, Weinheim, 1954, Bibliogr.; W r e t 1 i n d A. The pharmacological basis for the use of fat emulsions in intravenous nutrition, Acta chir, scand., v. 128, Suppl. 325, p. 31, 1964.


P. S. Vasilyev, O. K. Gavrilov, T. V. Polushina.

Яндекс.Метрика