PERFUSION

From Big Medical Encyclopedia

PERFUSION (Latin perfusio douche, injection) — a method of food of biological fabrics or leading of biologically active agents by a transmission of normal saline solutions, blood, blood-substituting or other liquids via veins of any body, a part of a body or all organism; blood supply of body organs under natural conditions (e.g., kidneys, brain, etc.).

The first attempts of P. biol, objects, first of all the isolated bodies (a brain, heart, etc.), were undertaken in the second half of 19 century Sh. Broun-Sekar in 1858 for the first time recovered signs of life in the head of a dog isolated from a trunk by a transmission of an arterial blood through its vessels. Later I. P. Pavlov with sotr. (1887) and E. Starling (1898) developed models of heart-lung preparation, in Krom P. of an isolated heart of a dog was carried out by the blood oxygenated in own lungs and coming to an aorta due to forcing by its left ventricle of heart (autoperfuziya). Langendorff (O. of Langendorff, 1887) made the item of an isolated heart through an aorta oxygenic solution of Ringer — Locke. In 1902 A. A. Kulyabko by means of P. managed to recover an isolated heart of the person in 20 hours after death, and S. V. Andreyev in 1946 — in the 99th hour. In 1924 — 1928 S. S. Bryukhonenko and S. I. Chechulin carried out P. of the isolated head of a dog by means of the cardiopulmonary bypass replacing heart and lungs of an animal (see. Bryukhonenko avtozhektor ).

In experimental practice by means of P. of the isolated bodies, fabrics and cells study biochemical and fiziol, features of their life activity. Such P. is also way of identification and receiving biologically active agents (mediators, hormones, enzymes, etc.).

In the whole organism thanks to P. replacement or the help of pumping function of heart (artificial creation of blood circulation), maintenance of metabolism, gas exchange, thermal control, and also intensive delivery to fabrics and bodies of nutritious and medicinal substances is carried out. The item can be full — full extracorporal blood circulation by means of «devices heart — lungs» (see. Artificial circulation ), partial — for maintenance of gas exchange — auxiliary oxygenation, for the help to heart — artificial circulatory support (see) and for maintenance of metabolism (see. Hemodialysis , Hemosorption , Dialysis , Artificial kidney , Limfosorbtion , Peritoneal dialysis ).

Depending on type of the vessels used for P. distinguish the venovenozny, arterio-arterial and mixed venoarterialny perfusion. At veno-venous P. jugular and femoral veins connect, at arterio-arterial P. — these or those femoral arteries, at the mixed P. — a femoral or jugular vein to a femoral artery.

The elementary scheme P. of the isolated bodies and fabrics turns on the thermostabilizing camera, in to-ruyu fabric or body are placed. Via veins of body under pressure perfused liquid is banished. The item of fabrics (cells) is carried out by flowing washing of drugs in the camera. Liquid is saturated with oxygen or Carbogenum (the mix consisting for 95% of oxygen and for 5% of carbon dioxide gas). At the same time the determined temperatures, pH, pO are maintained 2 and pCO 2 Wednesdays, speed of fluid movement or level of developed pressure etc.

For leading of medicinal substances to the fabrics which are rather isolated from the general vascular bed of areas or bodies for the purpose of influence of medicine directly on the center patol, process and decrease in its toxic action on an organism Items are used regional and organ.

At temporary replacement for gas exchange function of lungs and pumping function of heart mechanical devices (at heart operations and the main vessels) there are fiziol, no interaction and intercommunications between an organism and an artificial organ. Therefore adequate supply of an organism with oxygen requires artificial regulation and maintenance of optimum hemodynamic and hematologic parameters. G this purpose apply the so-called ideal P. based on the principle of the maximum approach fiziol, constants of a perfusing organism to normal, doperfu-zionny, to value. It is reached by a rational temperature schedule, the choice of blood vessels and kommutation of perfused system for ensuring the maximum rate of volume flow of P., use of perfusate with the indicators coming to parameters of blood of the patient, carefully controlled and managed artificial hemophilia, use sovr, the pumps and systems allowing to create the pulsing blood stream, use of membrane oxygenators (see).

The item of the bodies which are in an organism, but isolated from its general vascular bed is widely used for studying of mechanisms of nervous control.

Use of perfusion in clinic

In cardiac clinics at prosthetics of the aortal valve, correction of multivalve heart diseases and correction of heart diseases at children of chest age is applied to protection of a myocardium against a hypoxia the regional P. of heart which is carried out by means of the special device (see. Artificial circulation ) by catheterization of a coronary sine, coronary arteries or the basis of an aorta with the subsequent its crossclamping; Items carry out in the conditions of a normotermiya or a hypothermia (see. Hypothermia artificial ).

Koronarokaro-tidny P. Sushchnost's method of a method is applied to correction of heart diseases consists in regional P. of the head and hearts with the temporary termination of a blood-groove on the descending aorta» This type of P. is carried out by catheterization of carotid arteries, top and bottom venas cava and an aorta. Corona-rokarotidnaya P. who is carried out in the conditions of a normotermiya leads usually to accumulation of nedookislenny products of exchange in a lower body; washing away them in the general circle of blood circulation nullifies results of the previous work. Carrying out to-ronarokarotidnoy P. in the conditions of a hypothermia increases tolerance of internals to an anoxia.

In certain cases for correction of inborn heart diseases (defect of an interatrial partition,

the isolated stenosis of a pulmonary artery) use the isolated perfusion of the head in combination with a hypothermia. Perfusion is carried out by catheterization of a carotid artery (cooling of the head to t ° 17 — 18 °). This method is applied also in neurosurgery: an operative measure is carried out on a bloodless brain.

At treatment of inflammatory processes, thrombophlebitis and tumors use the isolated P. of the lower extremity; The Item is carried out by catheterization of a femoral artery and a vein with an applying a tourniquet places of catheterization are higher.

In chemotherapy of tumoral processes regional P. of lungs, a liver, bodies of a small pelvis, abdominal organs is applied. So, Creech (O. of Creech) developed regional P.'s method of lungs, W. G. Austen — P. of bodies of a small pelvis at tumors; The Item of abdominal organs offered W. W. Shingleton with soavt, in 1960. Perfusion of a liver was carried out by Ausman and Aust (V. K. of Ausman, J. Century of Aust) in 1960. In their opinion, P. of a liver can be applied to treatment of tumors, inflammatory processes and various intoxications; Items carry out through a hepatic artery and a portal vein.

Regional P.'s method found broad application in transplantology for preservation of body (see. Conservation of bodies and fabrics ). The essential advantage of this method is the possibility of assessment of a condition of body during the Item. The wide practical experience is accumulated on change of a cadaveric kidney (see. Renal transplantation ). As a rule, the kidney after hypothermal P. is placed in special solution with t ° 4 ° and stored in conditions of a giperbariya (see. Hyperbaric oxygenation ), what allows to bring out of it products of metabolism and to keep low level of oxidation-reduction processes. At treatment of an acute liver failure apply pork liver to P.

As a rule, P. is carried out by all above described methods by means of special devices, to-rye fill with a certain amount of blood or blood substitutes. The heparinized donor blood received in day of operation and which is picked up for the AB0 system and a Rhesus factor was considered as originally ideal perfused environment. However experience showed that use of blood as perfusate conducts to such complications as a syndrome of homologous blood which is result immunol, incompatibility (see. P erelivany blood ), the Syndrome of homologous blood is shown by disturbance of microcirculation, decrease in the ABP, increase venous and reduction of total amount of the circulating blood etc. Besides, as I. R. Drobinsky (1961), Adashek showed (E. P. Adashek, 1963), the Lithuanian Jew (R. S. Litwak, 1972), use of blood as perfusate creates danger of infection of patients with the Australian antigen causing serumal hepatitis.

Implementation of a method hemodilutions (see) much reduced quantity of the complications caused by a syndrome of homologous blood. Apply crystalloid solutions to hemodilution (isotonic solution of sodium chloride, Ringer's solution — Locke, 5% solution of glucose, etc.), colloidal solutions (Gelatinolum, a gematel, reomakrodeks, reopoliglyukin). Hemodilutions improves rheological properties of blood, normalizes microcirculation, however danger of transfer of a viral hepatitis remains.

Improvement of the perfused equipment led to creation of devices with a small volume of filling that gave the chance to exclude donor blood from perfusate. For the first time P. without donor blood carried out in 1959 Mr. Neptyyun (W. Century of Neptune). Perfusion without donor blood was carried out to the USSR in 1962 by A. N. Bakulev with sotr. As perfusate use also svezheotmyty or defrozen washed erythrocytes. Also researches on use of the special connections capable as perfusate to transfer oxygen are perspective.



Bibliography: Andreyev S. V. Recovery of action of the heart of the person after death, M., 1955; Ballyuzek F. V. and Farshatov M. N. Partial perfusion in surgery of extremities, JI., 1965; Burakovsky V. I., etc. Complications at open heart operations, M., 1972, bibliogr.; Vishnevsky A. A. and d river. Regional artificial circulation of a brain and heart in a heart surgery, M., 1968; Gaspar yan S. A., Ostroverkhov G. E. and Trapeznikov H. H. Regional long intra arterial chemotherapy of malignant tumors, M., 1970; D e of m and x about in V. P. Change of vitals in an experiment, M., 1960; Dokukin A. V. Hemodynamic bases of a synchronized artificial circulatory support, M., 1972; The Multivolume guide to pathological physiology, under the editorship of H. N. Sirotinina, t. 3, page 580, M., 1966; Osipov V. P. Bases of artificial circulation, M., 1976; P and with and r e of Sunday to and y A. A. Classification of methods and cardiopulmonary bypasses, Eksperim, hir. and anesteziol., No. 5, page 83, 1974; Problems of artificial heart of e of an artificial circulatory support, under the editorship of B. V. Petrovsky and V. I. Shumakov, M., 1970; Tkachenko B. I., etc. Regional and system vasomotor reactions, JI., 1971; Management of functional activity of bodies at perfusion, under the editorship of I. I. Gitelzon, Novosibirsk, 1981; Filatov A. N. and Ballyuzek F. V. The managed hemodilution, D., 1972; Folkov of B. and H and l E. Blood circulation, the lane with English, M., 1976; A b about u n a G. M and. lake of Treatment of hepatic coma by extracorporeal pig-liver perfusion, Lancet, v. 1, p. 64, 1969; In a-ker P. F.^ Hodgkin A. L. a. S h a w T. I. The effects of changes in internal ionic concentrations on the electrical properties of perfused giant axons, J. Physiol. (Lond.), v. 164, p. 355, 1962; Bartleltt M. G., N kposongE.a. Richards B. Extra-corporeal perfusion an arteriovenous shunt as a method of functional assessment of preserved kidney, Brit. J. Surg., v. 57, p. 380, 1970; Berkowits H.D. o. Kenal function in isolated perfused kidney, Surg. Gynec. Obstet., v. 127, p. 1257, 1968; Caine R. o. Liver transplantation in man, Brit. med. J., v. 4, p. 541, 1968; Carrel A. Lindbergh Ch. A. The culture of organs, N. Y., 1938; Creech O., K remen t z E. T. and. To about k a m e G. M of Bleeding problems in regional chemotherapy, Ann. N. Y. Acad. Sci., v. 115, p. 357, 1964; Golomb F. M. a. o. Chemotherapy of human cancer by regional perfusion, Cancer, v. 15, p. 828 *, 1962; Mechanical support of the failing heart and lungs, ed. by D. Bergman, N. Y., 1977; Perfusion techniques, ed. by E. Dicz-falusy, Copenhagen, 1972; Z a p about 1 W. M, S n i d e of M. T. a. Schneider R. Page of Extracorporeal membrane oxygenation for acute respiratory failure, Anesthesiology, v. 46, p. 272, 1977.


B. A. Makarychev; Century of H. Zagvozkin (cards.).

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