LIMFOSORBTION (Latin lympha pure water, moisture + to absorb sorbere) — the method of a detoxication of an organism based on clarification of the central lymph from toxic metabolites by means of various adsorbents. The term «limfosorbtion» is entered by analogy with the known term «hemosorption» (see. Hemosorption ) in 1974 when it began to be applied in a wedge, practice.
At various diseases of abdominal organs (diffuse purulent peritonitis, destructive pancreatitis, cirrhosis, hepatitis, etc.) or poisonings with exogenous poisons the acute liver failure develops. At the same time toxic metabolites, to-rye a liver could not neutralize, arrive in limf, system. As a result color of the central lymph changes, the content in it of ammonia, urea, residual nitrogen, bilirubin, potassium, sodium, calcium increases, activity of trypsin, a lipase, amylase, inhibitor of trypsin increases; there is an increase in osmotic pressure lymph (see). Such lymph received by outside drainage of a chest channel can be cleared by extracorporal perfusion through a special column with adsorbents: active coals (see) or ion-exchange resins (see. Ionites ).
For L. apply active coals in the form of granules of the following brands: active recuperation AR-3 coals, spherical peat SKT-6a coal, the BAU birch active coal, a spherical sorbent on the basis of the IGI fossil coals, nitrogen-containing synthetic sorbents of SKN and SUGS. Ion-exchange resins use in the form of spherical grains; apply the following brands of pitches: KU-2-8, Daueks 50-8, Amberlit of IP-120, AV-17-8, MHTI-2, etc.
L. carry out in sterile conditions. Surgical intervention at L. consists of the following stages: catheterizations chest channel (see), extracorporal clarification of a lymph from toxic products and reinfusion of the cleared lymph intravenously with simultaneous administration of the substances absorbed by adsorbents.
The combined cross-length supraclavicular access developed by B. M. Urtayev is convenient for finding of terminal department of a chest channel. The cannula is entered into the area of the ascending knee of an arch where the chest channel is located superficially and its allocation not traumatic.
Apply various columns filled with adsorbent to clarification of a lymph. As a rule, the column is a cylinder from plexiglas, on end faces to-rogo there is a carving for a navinchivaniye of covers. Between a cover and the cylinder kapron grids with cells to dia are placed. 0,2 — 0,3 mm for prevention of hit of particles of adsorbents in a circulatory bed. Covers of a column have the union for input and output of a lymph.
Adsorbents will sterilize autoclaving or ionizing radiation. It is reasonable to apply them selectively. So, for removal from a lymph of bilirubin, residual nitrogen, ammonia, urea use nitrogen-containing synthetic sorbents or recuperation active coals, for adsorption of trypsin with preservation of inhibitor of trypsin in a lymph — spherical peat SKT-6a coal or the BAU birch active coal. Cation-exchange resins completely absorb ammonia, to a lesser extent — electrolytes, urea and do not adsorb bilirubin at all. This ability AV-17-8, MHTI-2 anion-exchange resins, etc. have.
Use three methods of extracorporal clarification of a lymph: its transmission through a column with adsorbent with the subsequent introduction to a vein (a chest channel — a bottle — a column — a bottle — a vein); perfusion of a lymph through the adjusted intravenously drop system with the column which is built in in it filled with adsorbent (a chest channel — a bottle — a column — a vein); connection of a column on the one hand to the drainage tube which is in a chest channel, and with another — to a catheter in a subclavial vein (a chest channel — a column — a vein).
L. apply in a complex with others to lay down. actions at an acute liver failure. The method is most effective in a prekomatozny state and at a hepatic coma of the I degree. At a hepatic coma of the II—IV degree effect of L. it is less expressed because of development of irreversible processes in an organism.
By means of L. it is liquidated limf, hypertensia, improves outflow of a lymph from a liver. L. creates conditions for normalization mikrogemo-and mikrolimfotsirkulyation, removal of toxins from a lymph provides, at the same time allows to avoid considerable loss of leukocytes, proteins, fats, carbohydrates, electrolytes and other substances that is observed at outside assignment of a lymph with to lay down. purpose.
At L. constant overseeing by patients and compensation of all substances is necessary, to-rye are absorbed by adsorbents: carry out hemotransfusion, plasmas, blood-substituting solutions.
Carrying out L. can cause complications and reactions, to-rye are divided into three groups. Disturbance of catheterization of a chest channel can be complicated by damage of vessels of a venous corner, postoperative pheumothorax, paresis of a vagus nerve, bleeding, and also loss of a drainage tube with formation of a temporary limfofistula, dribble of a lymph around a catheter.
As a result of disturbance of conditions of adsorption process of clarification of a lymph can be complicated by partial or full coagulation of a lymph, decrease in an absorbing capacity of adsorbents, minor change of structure of a lymph.
In the course of transfusion of the cleared lymph there can be such complications as embolisms, the pyrogenic reactions, infection of a lymph, disturbance of a hemodynamics at introduction of a cold or superheated lymph.
Bibliography: Alekseev A. A., Buyanov V. M. and Ognev Yu. V Surgical technology of drainage of a chest lymphatic channel, Vestn, hir., t. 120, No. 3, page 12, 1978; Ballyuzek F. V. Catheterization of a chest lymphatic channel, in the same place, t. 112, No. 3, page 33, 1974, bibliogr.; Hemosorption, under the editorship of Yu. M. Lopukhin, page 64, M., 1977; To about r B. A. au lion and and at sh and V. A. Hirurgiya's N of cirrhoses of a liver, page 107, M., 1973; Lopukhin Yu. M. and M about l about d e of the Tax Code about in M. N. Gemosorbtion, page 118, M., 1978; Panchenkov R. T., Yarema I. V. iurtayevb. M. Limfosorbtion in a complex of resuscitation actions, Anesteziol. and reanimatol., No. 5, page 52, 1977; Panchenkov R. T. ides of river. Reinfusion of the cleared lymph, Surgery, No. 7, page 96, 1976.
R. T. Panchenkov.