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National blood system: current status and prospects. Organization of transfusion care in a medical institution 国家血液系统:现状与展望。医疗机构中输血护理的组织
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-259-261
O. Sergiienko
Background. Blood safety is a system of measures to organize equal and timely access of citizens to high-quality and safe components of donated blood in the required quantity, their safe and proper use, as well as the safety of donors and patients. Objective. To describe the state and prospects of the development of national blood system. Materials and methods. Analysis of available regulatory documents and literature sources. Results and discussion. In Ukraine, there is a need to create a sustainable self-sufficient national blood system, which could include both the provision of services by medical institutions and the supervision of their provision. This system should be based on voluntary gratuitous donation. It is also necessary to coordinate and standardize such processes as blood procurement, processing, testing for transfusion-transmission infections, determination of blood group and rhesus, storage, distribution, transportation of blood and its components, monitoring of adverse reactions. The hospital transfusion committee (HTC), the hospital blood bank (HBB) and the transfusion immunological laboratory should be the part of the transfusion service of health care facilities. The functions of HTC are to determine the algorithms for the organization of transfusion care, to establish the rules for the appointment of blood and its components, and to assist in education and training of personnel and more. In turn, the functions of HBB include centralized receiving, accounting, storage and dispensing of blood or its components, control of transportation and storage of blood, introduction of alternative therapeutic transfusion methods, control of clinical efficacy assessment, hemovigilance, control of the records and documents of transfusion assistance. It is recommended to allocate four rooms for HBB: for receiving, storage and distributing blood; for collecting and processing applications; for immunohematological examinations and for the staff. Requirements for the provision of blood transfusion services in a health care facility include the organization of the listed above units, inventory management, guidance on the proper use of blood components, quality management, reporting system, and staff training. The blood centre and health care facility must work together to manage blood supplies. When transporting blood, it is extremely important to adhere to the cold chain from the moment the blood is received from the donor to the transfusion of its components to the recipient. Blood and erythrocyte-containing blood components should be stored at 2-6 °C to prevent hemolysis and microbial contamination. Plasma blood components need to be stored frozen (-30 °C), and platelet-containing – in a thermoshaker at a temperature of 20-24 °C. Depending on the type of preparation, plasma, erythrocyte and platelet preparations may have different clinical efficacy. Before transfusion, the doctor must perform a macroscopic assessment of the suitability of
背景。血液安全是组织公民平等和及时获得所需数量的高质量和安全的献血成分,安全正确使用以及献血者和患者安全的一整套措施。目标。描述了国民血液系统的发展现状和前景。材料和方法。分析现有的法规文件和文献来源。结果和讨论。在乌克兰,需要建立一个可持续的自给自足的国家血液系统,其中可包括医疗机构提供的服务和对其提供的监督。这一制度应以自愿无偿捐赠为基础。还需要协调和规范血液采购、加工、输血传播感染检测、血型和恒河型测定、血液及其成分的储存、分配、运输、不良反应监测等过程。医院输血委员会(HTC)、医院血库(HBB)和输血免疫实验室应成为卫生保健机构输血服务的组成部分。HTC的职能是确定组织输血护理的算法,建立血液及其成分的任命规则,并协助人员的教育和培训等。反过来,HBB的功能包括血液或其成分的集中接收、核算、储存和分配,控制血液的运输和储存,引入替代治疗性输血方法,控制临床疗效评估,血液警戒,控制输血援助的记录和文件。建议为HBB分配4个房间:用于接受、储存和分配血液;收集及处理申请书;用于免疫血液学检查和工作人员。卫生保健机构提供输血服务的要求包括上述单位的组织、库存管理、正确使用血液成分的指导、质量管理、报告制度和工作人员培训。血液中心和卫生保健机构必须共同努力,管理血液供应。在运送血液时,从献血者接受血液的那一刻起,到将其成分输血给接受者,坚持冷链是极其重要的。血液和含红细胞的血液成分应保存在2-6°C,以防止溶血和微生物污染。血浆血液成分需要冷冻保存(-30°C),并在温度为20-24°C的恒温器中保存含血小板。根据制剂的类型,血浆、红细胞和血小板制剂可能具有不同的临床疗效。输血前,医生必须对血液制品的适宜性进行宏观评估,确定受者的血型和恒河,与患者病历进行比对,确定供者的血型和恒河,与塑料容器标签进行比对,进行血液相容性试验,进行临床和生物学试验。关于输血严重危害(SHOT)的报告表明,有些输血不良反应是无法预防的,也有些反应是可以通过改进操作和控制来避免的,以及与人有关的反应。血液警戒在血液系统的功能中起着重要的作用。血液警戒的优点是识别不良反应的趋势,揭示输血医学有待改进的领域,刺激研究,提高对危险因素的认识,并提高患者输血的安全性。结论:1。在乌克兰,需要建立一个稳定的自给自足的国家血液系统。2. 有必要协调和规范采购、加工、输血传播感染检测、血型和恒河血型测定、血液及其成分的储存、分配、运输、不良反应监测等过程。3.血液警戒在血液系统的功能中起着重要的作用。
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引用次数: 0
Rheo-STAT project. New options of the intoxication syndrome therapy from the point of view of the evidence: accent on pneumonia Rheo-STAT项目。从证据的角度看中毒综合征治疗的新选择:强调肺炎
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-82-83
Dinh Thi Hoa, S. Beridze
Background. Pneumonia is a widespread disease and an often cause of hospitalizations both in Vietnam and Georgia. The supportive treatment of pneumonias includes the respiratory support, the support of fluid and electrolyte balance, parenteral nutrition and some additional drugs (analgesics, corticosteroids, inotropes). Rheo-STAT study is an interventional open-label randomized controlled study of Reosorbilact (“Yuria-Pharm”) effectiveness in pneumonia treatment. The study was held in 7 countries (Ukraine, Moldova, Georgia, Vietnam, Kazakhstan, Kyrgyzstan, Uzbekistan). Objective. To assess Reosorbilact effectiveness in the elimination of the intoxication syndrome. Materials and methods. 628 adult patients with sepsis, peritonitis, pneumonias and burns took part in this study. The pneumonia subgroup included 150 people (62 % males, mean age – 41.3 years, 33 % had some concomitant diseases). Inclusion criteria were the following: age – 18-60 years, community-acquired pneumonia and antibiotic therapy, administered not later than after 48 hours after the disease beginning, at least IV class according to PSI/PORT index, the presence of informed consent, baseline level of SOFA points ≥2. The assessment according to the SOFA scale on the 3rd day of treatment in comparison to the baseline level was the primary endpoint. Secondary endpoints included the change of mean result according to other scales (APACHE II, SAPS II, MODS, PSI/PORT, CURB-65) and changes of biochemical, immunological and integral markers of endogenous intoxication. Results and discussion. Infusion therapy with the help of Reosorbilact (200-400 ml per day) led to the increase of circulating blood volume and to the decrease of total infusion volume without any risk of volume overload. Lactate – one of the Reosorbilact components – did not increase the endogenous lactate level, which testifies a high safety. Inclusion of Reosorbilact into the combined treatment in 3 days led to the body temperature decrease from 39.37 to 36.77 °С, heart rate decrease from 105.27 to 77.81 bpm, leucocytes amount – from 9.38 to 6.64×109/L. Blood oxygenation also increased at the 3rd day of treatment, and PSI/PORT index decreased from 101.47 to 49.07. Pulmonary edema or pleural effusion were not revealed in any patients. Conclusions. 1. Pneumonia is a widespread disease, which often requires hospitalization. 2. Infusion therapy with the help of Reosorbilact increases the circulating blood volume without a risk of volume overload. 3. Inclusion of Reosorbilact into the combined treatment of pneumonia in 3 days leads to the decrease of body temperature, heart rate, leucocyte amount and to the increase of blood oxigenation.
背景。肺炎是一种广泛存在的疾病,在越南和格鲁吉亚都经常导致住院治疗。肺炎的支持性治疗包括呼吸支持、液体和电解质平衡支持、肠外营养和一些附加药物(镇痛药、皮质类固醇、肌力药物)。Rheo-STAT研究是一项介入性开放标签随机对照研究,研究Reosorbilact(“Yuria-Pharm”)治疗肺炎的有效性。这项研究在7个国家进行(乌克兰、摩尔多瓦、格鲁吉亚、越南、哈萨克斯坦、吉尔吉斯斯坦、乌兹别克斯坦)。目标。目的:评价Reosorbilact在消除中毒综合征中的有效性。材料和方法。628例脓毒症、腹膜炎、肺炎和烧伤的成年患者参加了这项研究。肺炎亚组包括150人(62%为男性,平均年龄- 41.3岁,33%伴有某些疾病)。纳入标准如下:年龄- 18-60岁,社区获得性肺炎和抗生素治疗,不迟于疾病开始后48小时给药,根据PSI/PORT指数至少为IV级,存在知情同意,SOFA基线水平≥2。在治疗第3天根据SOFA量表与基线水平进行的评估是主要终点。次要终点包括其他量表(APACHE II、SAPS II、MODS、PSI/PORT、CURB-65)平均结果的变化以及内源性中毒的生化、免疫学和积分指标的变化。结果和讨论。Reosorbilact辅助输注治疗(200- 400ml / d)可使循环血容量增加,总输注量减少,且无容量过载风险。其中一种可吸收成分乳酸不增加内源性乳酸水平,证明其安全性高。在联合治疗的3天内,Reosorbilact使体温从39.37°降至36.77°С,心率从105.27°降至77.81 bpm,白细胞数量从9.38°降至6.64×109/L。治疗第3天血氧合升高,PSI/PORT指数由101.47降至49.07。所有患者均未发现肺水肿或胸腔积液。结论:1。肺炎是一种广泛传播的疾病,通常需要住院治疗。2. 在Reosorbilact的帮助下,输液治疗增加了循环血容量,而没有容量过载的风险。3.在肺炎联合治疗的3天内加入吸附剂可使患者体温、心率、白细胞数量下降,血氧含量升高。
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引用次数: 0
Pathogenetic syndrome management of a patient with COVID-19 1例COVID-19患者的发病综合征管理
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-298-299
E. Khodosh
Background. In case of coronavirus pneumonia, the virus damages the cells of bronchi and alveoli, as well as triggers a powerful inflammatory response that disrupts the surfactant and prevents the adequate oxygenation. These pathogenetic links lead to the development of acute respiratory distress syndrome, multiorgan hypoxia and disseminated intravascular coagulation syndrome. Objective. To find out the main pathogenetic links that can be affected by coronavirus disease (COVID-19) treatment. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Hypoxia is one of the main backgrounds of coronavirus organ damage in COVID-19. The consequences of hypoxia include the imbalance between aerobic and anaerobic glycolysis, increased lipid peroxidation, acidosis, microcirculation disorders, edema. Pathologically active inflammation is another background. It leads to the damage of pulmonary capillaries, microcirculation disorders and the development of acute respiratory distress syndrome with increased hypoxia. Since the reactive oxygen species are the main inducers of apoptosis and mitochondrial dysfunction, it is necessary to prescribe antioxidant therapy. Edaravone (Ksavron, “Yuria-Pharm”) quickly neutralizes lots of free radicals, inhibits lipid peroxidation and activates the own antioxidant defense. Other components of the pathogenetic therapy of COVID-19 may include Tivortin and Tivorel (“Yuria-Pharm”). L-arginine (Tivortin) is a nitric oxide donor. Its administration has vasodilating, immunostimulating, membrane stabilizing, cytoprotective and antioxidant effects. Tivorel also contains L-carnitine, which inhibits apoptosis, has antioxidant and cardioprotective effects. In case of pneumonia, it is advisable to use Reosorbilact (“Yuria-Pharm”), which prevents pulmonary edema and restores microcirculation. Conclusions. 1. Hypoxia and hyperinflammation are the main elements of the COVID-19 pathogenesis. 2. Edaravone (Ksavron) neutralizes free radicals and activates own antioxidant defense. 3. L-arginine (a component of Tivortin and Tivorel) has vasodilating, immunostimulating, membrane stabilizing, cytoprotective and antioxidant effects. 4. Reosorbilact prevents pulmonary edema and restores microcirculation.
背景。在冠状病毒肺炎的情况下,病毒会破坏支气管和肺泡细胞,并引发强烈的炎症反应,破坏表面活性剂,阻止充分的氧合。这些发病环节导致急性呼吸窘迫综合征、多器官缺氧和弥散性血管内凝血综合征的发展。目标。了解冠状病毒病(COVID-19)治疗可能影响的主要致病环节。材料和方法。对这一主题的文献来源进行分析。结果和讨论。缺氧是新冠病毒器官损伤的主要背景之一。缺氧的后果包括有氧和无氧糖酵解失衡、脂质过氧化增加、酸中毒、微循环障碍、水肿。病理性活动性炎症是另一个背景。导致肺毛细血管损伤,微循环障碍,发展为缺氧加重的急性呼吸窘迫综合征。由于活性氧是细胞凋亡和线粒体功能障碍的主要诱导剂,因此有必要给予抗氧化治疗。依达拉奉(Ksavron,“Yuria-Pharm”)能迅速中和大量自由基,抑制脂质过氧化,激活自身抗氧化防御。COVID-19病理治疗的其他组成部分可能包括替沃汀和替沃雷尔(“Yuria-Pharm”)。l -精氨酸(Tivortin)是一氧化氮供体。它具有血管扩张、免疫刺激、膜稳定、细胞保护和抗氧化作用。替佛瑞尔还含有左旋肉碱,能抑制细胞凋亡,具有抗氧化和心脏保护作用。如果是肺炎,建议使用Reosorbilact(“Yuria-Pharm”),它可以防止肺水肿,恢复微循环。结论:1。缺氧和高炎症是新冠肺炎发病机制的主要因素。2. 依达拉奉(Ksavron)能中和自由基,激活自身抗氧化防御。3.l -精氨酸(Tivortin和Tivorel的一种成分)具有血管扩张、免疫刺激、膜稳定、细胞保护和抗氧化作用。4. 吸山梨醇可预防肺水肿,恢复微循环。
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引用次数: 0
Problems of hematological toxicity during the treatment of blood system malignancies 血液系统恶性肿瘤治疗中的血液毒性问题
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-156-158
I. Kriachok
Background. Treatment of blood malignancies is often accompanied by the hematological toxicity. Thrombocytopenia is one of the most common phenomena, which can be caused by pseudothrombocytopenia, production deficiency or increased destruction of platelets, their pathological distribution or aggregation. Objective. To determine the features of hematological toxicity in the treatment of malignant blood diseases. Materials and methods. Analysis of literature data and recommendations on this topic. Results and discussion. Diagnosis of thrombocytopenia involves a detailed study of a peripheral blood smear to assess the morphology of all cells, as well as additional studies (determination of lactate dehydrogenase, D-dimer, fibrinogen, etc.; aspiration and bone marrow biopsy; virological and bacteriological studies; clinical examination). The main causes of thrombocytopenia in cancer patients are chemotherapy (ChT) and radiation therapy (RT), however, the diagnosis should take into account all possible nosological options. The assessment should be performed if the platelet count is <100,000/μl. The normal lifespan of platelets is 8-10 days, so after many types of ChT thrombocytopenia develops about 7th days after treatment, reaches a maximum of 14th days and ends in 28-35th days. After RT thrombocytopenia usually starts in 7-10th days after its termination and is present during 30-60 days. Before treating thrombocytopenia, the need for ChT should be re-evaluated and the risk of bleeding assessed, and the ChT regimen should be changed if possible. If the risk of bleeding is high or the platelet count is critically low, platelet transfusion is prescribed, however, it has recently been found that absolute platelet count is not a predictor of bleeding risk in this patient population (PLADO study). In addition, platelet transfusion is limited in resources and costly, and is accompanied by the risk of side effects (acute lung damage due to transfusion, fever, bacterial sepsis, development of transfusion intolerance). This became the basis for the search for alternative treatment options. Recombinant interleukin-11 (oprelvekin) reduces the need for platelet transfusion from 96 to 70 % of patients on ChT. However, although this drug is FDA-approved, it is characterized by a large number of side effects. In turn, thrombopoietin receptor agonists (subcutaneous romiplostin, oral eltrombopag) bind to the corresponding receptors and increase the number of platelets in the blood. The effectiveness of treatment is within 70 %. Emaplag (“Yuria-Pharm”) is the first and only eltrombopag in Ukraine. Emaplag is indicated for the treatment of thrombocytopenia caused by ChT in patients with solid tumors, patients with platelet counts <50×109/L, and in cases where the physician decides to increase platelet count. With regard to anemias, their main causes in cancer patients are the factors of the underlying disease (bone marrow infiltration, infectious processes), the impa
背景。血液恶性肿瘤的治疗常伴有血液毒性。血小板减少症是最常见的现象之一,它可以由假性血小板减少症、血小板生产不足或血小板破坏增加、血小板病理分布或聚集引起。目标。目的:探讨恶性血液病治疗的血液学毒性特点。材料和方法。本课题的文献资料分析及建议。结果和讨论。血小板减少症的诊断包括对外周血涂片的详细研究,以评估所有细胞的形态,以及额外的研究(乳酸脱氢酶、d -二聚体、纤维蛋白原等的测定;穿刺和骨髓活检;病毒学和细菌学研究;临床检查)。癌症患者血小板减少的主要原因是化疗(ChT)和放疗(RT),然而,诊断应考虑到所有可能的分类学选择。血小板计数<10万/μl时应进行评估。血小板的正常寿命为8-10天,因此在多种类型的ChT后,血小板减少在治疗后约7天开始,最多可达14天,并在28-35天结束。RT后血小板减少症通常在终止后7-10天开始,并在30-60天出现。在治疗血小板减少症之前,应重新评估ChT的需要和出血风险,如果可能的话,应改变ChT治疗方案。如果出血风险高或血小板计数极低,则规定输注血小板,然而,最近发现绝对血小板计数并不是该患者人群出血风险的预测因子(PLADO研究)。此外,血小板输注资源有限,费用昂贵,并伴有副作用的风险(输血引起的急性肺损伤、发热、细菌性败血症、输血不耐受的发生)。这成为了寻找替代治疗方案的基础。重组白细胞介素-11 (oprelvekin)使接受ChT治疗的患者的血小板输注需求从96%减少到70%。然而,虽然这种药物是fda批准的,但它的特点是副作用很多。反过来,血小板生成素受体激动剂(皮下romiplostin,口服eltrombopag)与相应的受体结合,增加血液中血小板的数量。治疗的有效性在70%以内。Emaplag(“Yuria-Pharm”)是乌克兰第一个也是唯一一个电子药物。Emaplag适用于治疗实体瘤患者、血小板计数<50×109/L的患者以及医生决定增加血小板计数的患者中由ChT引起的血小板减少症。至于癌症患者的贫血,其主要原因是潜在疾病的因素(骨髓浸润、感染过程)、ChT或RT的影响、其他原因(营养不良、出血、肾功能障碍)。贫血患者的检查应包括病史、血涂片及铁代谢评价、排除隐匿性胃肠道出血及肾功能衰竭、库姆斯试验、测定内源性促红细胞生成素。治疗方案包括输血和使用促红细胞生成素(epoetins α和β, darbepoetin)加或不加铁补充剂(口服或静脉注射)。使用促红细胞生成素的优点包括减少红细胞输注的需要,逐渐增加血红蛋白,提高生活质量。然而,促红细胞生成素不推荐用于未接受ChT或RT治疗的癌症患者,因为在这些情况下,促红细胞生成素的使用与死亡风险增加有关。由于在某些患者群体中,促红细胞生成素会加速肿瘤生长或降低生存率,因此患者使用促红细胞生成素必须给予书面知情同意。鉴于这些数据,建议静脉注射铁,因为它不仅可以迅速增加血红蛋白和改善生活质量,而且还可以减少促红细胞生成素的剂量。羧麦芽糖铁是最现代的肠外铁制剂。具有低毒性、高稳定性的特点。结论:1。血栓浓缩输血是纠正血小板减少症的一种快速有效的方法,但它有许多缺点。2. 血小板生成素受体激动剂(eltrombopag)可以在不中断计划治疗的情况下增加治疗的有效性。3.在出现贫血的情况下,在开促红细胞生成素处方之前,应纠正所有可能的原因。4. 如果贫血是由ChT引起的,患者需要服用促红细胞生成素。5. 在促红细胞生成素治疗中加入静脉铁制剂可显著提高治疗效果。
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引用次数: 0
Monitoring of blood clotting during bleeding 监测出血过程中的血液凝固情况
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-12-13
A. Ahmed
Background. The risk of bleeding and thrombotic events should be weighed before, during and after surgery. To facilitate this process, it is advisable to ask yourself the following questions: if we start the operation now, will the bleeding develop? If we delay the intervention, will a thrombotic event occur? Are the patient’s antithrombotic drugs effective? Objective. To describe the blood coagulation monitoring system. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Coagulopathy can be congenital and acquired, the latter including iatrogenic. The causes of congenital coagulopathies include hemophilia, von Willebrand factor deficiency, thrombocytopenia, and antiphospholipid syndrome. Antiplatelet drugs and direct oral anticoagulants are the main causes of iatrogenic coagulopathies. Other causes of acquired coagulopathies include hemostasis failure, disseminated intravascular coagulation syndrome, and post-surgical coagulopathies of various types. In order to treat bleeding in coagulopathies, desmopressin, tranexamic acid, coagulation factors, and protamine are administered. Laboratory tests needed to detect coagulopathies include prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, fibrinogen levels, and coagulation factors. The limitations of these tests include their non-dynamic nature, lack of ability to predict the risk of bleeding, time and financial costs, inability to understand the pathophysiological mechanism of bleeding. There may also be an error in the analysis due to the addition of citrate and calcium to the samples. Rapid tests to assess the hemostasis system include determination of activated coagulation time, Hepcon heparin monitoring system, thromboelastography and platelet mapping, platelet aggregometry using multiple electrodes, rotational thromboelastometry, and sonoreometry. Conclusions. 1. For best results, coagulopathy should be anticipated, detected, and treated in a timely manner. 2. The strength of blood clots depends on platelets and fibrinogen. 3. It is advisable to use rapid tests to assess hemostasis and repeat them regularly, as bleeding and blood clotting are dynamic processes. 4. The effects of hemodilution, acid-base balance and temperature should be kept in mind.
背景。出血和血栓事件的风险应在手术前、手术中和手术后进行权衡。为了方便这个过程,建议问自己以下问题:如果我们现在开始手术,出血会发展吗?如果我们延迟干预,会发生血栓事件吗?患者的抗血栓药物是否有效?目标。介绍了血凝监测系统。材料和方法。对这一主题的文献来源进行分析。结果和讨论。凝血功能障碍可以是先天性的也可以是后天的,后者包括医源性的。先天性凝血病的病因包括血友病、血管性血友病因子缺乏症、血小板减少症和抗磷脂综合征。抗血小板药物和直接口服抗凝剂是医源性凝血病的主要原因。获得性凝血功能障碍的其他原因包括止血失败、弥散性血管内凝血综合征和各种类型的术后凝血功能障碍。为了治疗凝血疾病出血,给予去氨加压素、氨甲环酸、凝血因子和鱼精蛋白。检测凝血功能障碍所需的实验室检查包括凝血酶原时间、活化的部分凝血活酶时间、凝血酶时间、国际标准化比率、纤维蛋白原水平和凝血因子。这些测试的局限性包括它们的非动态性,缺乏预测出血风险的能力,时间和经济成本,无法了解出血的病理生理机制。由于样品中添加了柠檬酸盐和钙,分析中也可能出现误差。评估止血系统的快速测试包括测定活化凝血时间、Hepcon肝素监测系统、血栓弹性成像和血小板制图、使用多个电极的血小板聚集、旋转血栓弹性测量和超声测量。结论:1。为获得最佳效果,凝血功能障碍应及时预测、检测和治疗。2. 血凝块的强度取决于血小板和纤维蛋白原。3.建议使用快速测试来评估止血,并定期重复,因为出血和凝血是动态的过程。4. 应牢记血液稀释、酸碱平衡和温度的影响。
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引用次数: 0
Infusion therapy in the internal diseases’ propaedeutics 输液治疗在内科疾病预防学中的应用
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-306-308
V. Chernii
Background. Infusion therapy (IT) is one of the main methods of drug therapy optimization. The essence of IT is to correct homeostasis disorders in order to detoxify, to restore the disrupted microcirculation and tissue perfusion, to eliminate the disorders of rheological and coagulation blood properties, to eliminate metabolic disorders, to improve drug delivery to the pathological focus, to restore circulating blood volume, to normalize fluid and electrolyte and acid-base balance. Objective. To describe modern IT. Materials and methods. Analysis of the literature sources on this topic. Results and discussion. Requirements for modern plasma substitutes include safety, sufficient and long-lasting volemic effect, rapid renal excretion, lack of accumulation and effect on the coagulation system, maximum similarity to blood plasma, and availability. There are several classes of plasma substitutes, and each of them has its own indications. For example, crystalloids are prescribed for dehydration, and colloids – for hypovolemia. The infusion volume is calculated based on the physiological needs of the organism, taking into account pathological fluid loss (fever, shortness of breath, postoperative wound drainage, vomiting, polyuria). Endogenous intoxication (EI) – a pathological condition that occurs as a result of exposure to toxic substances of exogenous or endogenous nature, which cause dysfunction and the development of extreme conditions – is an important field of IT application. EI can accompany chronic heart failure, peripheral vessels atherosclerosis, autoimmune and allergic diseases. Toxins have a direct (direct destruction of proteins and lipids, blocking of synthetic and oxidative processes in the cell) and indirect (microcirculation system and vascular tone disorders, changes of blood rheological properties) adverse effects. Clinical manifestations of EI include fever, malaise, and the dysfunction of various internal organs. As EI depletes the natural mechanisms of detoxification, worsens the clinical course of the disease, reduces drug sensitivity, suppresses immunity, it is an indication to detoxification via infusion. The tasks of the latter are to improve tissue perfusion, to provide hemodilution with a decrease in the toxins’ concentration, to stimulate diuresis, to eliminate acidosis, and to maintain the functional state of hepatocytes. For this purpose, solutions of polyatomic alcohols (Reosorbilact, Xylate, “Yuria-Pharm”) can be used. Reosorbilact increases the circulating blood volume, improves microcirculation and rheological blood properties, increases tissue perfusion, promotes “wash-out” of toxins, corrects acidosis and fluid and electrolyte balance, normalizes hepatocyte function, improving the own detoxification mechanisms. In case of microcirculation disturbances, it is reasonable to use the combined IT with the inclusion of Reosorbilact, Latren and Tivortin (“Yuria-Pharm”). Latren increases the elasticity of erythrocytes,
背景。输液治疗是优化药物治疗的主要方法之一。IT的本质是纠正体内平衡紊乱,以便解毒,恢复被破坏的微循环和组织灌注,消除血液流变学和凝血特性的紊乱,消除代谢紊乱,改善药物对病理病灶的输送,恢复循环血容量,使液体、电解质和酸碱平衡正常化。目标。描述现代IT。材料和方法。本课题的文献来源分析。结果和讨论。对现代血浆替代品的要求包括安全性、充分和持久的容血作用、快速的肾脏排泄、缺乏积聚和对凝血系统的影响、与血浆的最大相似性和可用性。血浆替代品有好几类,每一类都有自己的适应症。例如,晶体类药物用于脱水,胶体类药物用于低血容量。输液量是根据机体的生理需要计算的,同时考虑到病理性体液流失(发热、呼吸短促、术后伤口引流、呕吐、多尿)。内源性中毒(EI)是一种由于暴露于外源性或内源性有毒物质而导致功能障碍和极端情况发展的病理状态,是IT应用的一个重要领域。EI可伴随慢性心力衰竭、外周血管粥样硬化、自身免疫性疾病和过敏性疾病。毒素有直接的(直接破坏蛋白质和脂质,阻断细胞内的合成和氧化过程)和间接的(微循环系统和血管张力紊乱,血液流变学特性的改变)不利影响。EI的临床表现为发热、不适、脏腑功能紊乱。由于EI耗竭自然解毒机制,加重疾病临床病程,降低药物敏感性,抑制免疫,是输注解毒的指征。后者的任务是改善组织灌注,通过降低毒素浓度提供血液稀释,刺激利尿,消除酸中毒,维持肝细胞的功能状态。为此,可以使用多原子醇(Reosorbilact, Xylate,“Yuria-Pharm”)的溶液。Reosorbilact增加循环血容量,改善微循环和血液流变学特性,增加组织灌注,促进毒素的“冲洗”,纠正酸中毒和液体和电解质平衡,使肝细胞功能正常化,改善自身的解毒机制。在微循环紊乱的情况下,合理使用含Reosorbilact, Latren和Tivortin(“Yuria-Pharm”)的联合it。Latren增加红细胞的弹性,减少红细胞和血小板的聚集,使血浆电解质组成正常化,Tivortin作为一种底物形成一氧化氮-内皮细胞的主要信号分子。除EI外,糖尿病酮症酸中毒也常使用IT。在这种情况下,建议使用Xylate(“Yuria-Pharm”),它具有抗生酮特性,改善血液动力学,纠正酸中毒,并且不增加血糖水平。建议仅在等渗盐水溶液帮助下初步补液后使用木酸盐。结论:1。它是治疗许多疾病的重要方法。2. EI不仅伴随中毒综合征的疾病,而且几乎伴随所有的内科疾病。3.Reosorbilact和Xylate是解毒的最佳解决方案。4. 合理使用组合It,例如,Reosorbilact与Latren和Tivortin组合使用。
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引用次数: 0
Options of the placental dysfunction correction in women with preeclampsia 子痫前期妇女胎盘功能障碍矫正的选择
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-111-112
Amrullo Karimov, D. M. Davlietova
Background. Placental dysfunction (PD) is one of the most common complications of pregnancy, which has not only medical but also social significance. The links of the PD pathogenesis include endothelial dysfunction, hemodynamic disorders of the placental vessels, disorders of arterial and venous blood flow in the placenta. Objective. To study diagnostic methods and possibilities of PD correction in women with preeclampsia (PE). Materials and methods. The study involved 68 women with PE in the II and III trimesters of pregnancy, treated at the multidisciplinary clinic of the Tashkent Medical Academy during 2017-2019. Patients underwent standard clinical, laboratory and instrumental examination with color Doppler mapping of vessels of the uterine-placental-fetal system and ultrasound evaluation of the fetoplacental system. Results and discussion. Premature aging of the placenta was found in 77.3 % of cases, turbid amniotic fluid – in 59.09 %, oligohydramnion – in 27.3 %. Disorders of uteroplacental blood flow were detected in 28.3 % of cases, placentofetal blood flow – in 26.7 %. Impaired blood flow at both levels without critical values occurred in 10 % of pregnant women. In case of insufficiency of a blood circulation of 2nd grade the syndrome of fetal growth restriction was observed in 16,7 % of cases. Compensated forms of PD were subject to the comprehensive treatment with the addition of infusions of L-arginine (Tivortin, “Yuria-Pharm”) in the inpatient phase and oral administration of Tivortin aspartate in the outpatient phase. The length of the fetal thigh in the group of L-arginine at the beginning of treatment was 47.33 mm, which was by 9.04 % less than this parameter in physiological pregnancy. After treatment with Tivortin, in the full-term period, no significant difference was found. In pregnant women who received L-arginine at 25-29 weeks of pregnancy, after 2 weeks, the resistance indices (RI) of the umbilical artery and uterine artery decreased from 0.68±0.09 to 0.58±0.05 and from 0,58±0.16 to 0.43±0.08, respectively. The RI of the middle cerebral artery increased from 1.05±0.23 to 1.27±0.19. Parameters of RI dynamics indicate that the early treatment with Tivortin is more effective than late. Conclusions. 1. Regardless of the presence of fetal growth restriction syndrome in women with disorders of uterine-placental-fetal circulation, it is advisable to include L-arginine in the treatment to prevent this condition. 2. Ultrasound examination is a reliable method for evaluating the effectiveness of PD treatment.
背景。胎盘功能障碍(PD)是妊娠期最常见的并发症之一,不仅具有医学意义,而且具有社会意义。PD发病的环节包括内皮功能障碍、胎盘血管血流动力学紊乱、胎盘内动、静脉血流量紊乱。目标。探讨女性子痫前期PD矫正的诊断方法及可能性。材料和方法。该研究涉及68名妊娠二、三期PE患者,2017-2019年期间在塔什干医学院多学科诊所接受治疗。患者接受标准的临床、实验室和仪器检查,包括子宫-胎盘-胎儿系统血管的彩色多普勒测绘和胎儿-胎盘系统的超声评估。结果和讨论。胎盘早衰占77.3%,羊水混浊占59.09%,羊水过少占27.3%。子宫胎盘血流异常占28.3%,胎盘胎儿血流异常占26.7%。10%的孕妇出现两种水平的血流受损,但没有达到临界值。在2年级血液循环不足的情况下,胎儿生长受限综合征在16.7%的病例中被观察到。代偿型PD在住院期接受l -精氨酸(Tivortin,“Yuria-Pharm”)输注的综合治疗,在门诊期口服天冬氨酸Tivortin。治疗初期l -精氨酸组胎儿大腿长度为47.33 mm,比生理妊娠时缩短9.04%。经替沃汀治疗后,足月无明显差异。妊娠25 ~ 29周服用l -精氨酸的孕妇,2周后脐动脉和子宫动脉阻力指数(RI)分别由0.68±0.09降至0.58±0.05,由0.58±0.16降至0.43±0.08。大脑中动脉的RI由1.05±0.23增加到1.27±0.19。RI动力学参数表明,早期使用Tivortin治疗比晚期治疗更有效。结论:1。无论子宫-胎盘-胎儿循环紊乱的妇女是否存在胎儿生长受限综合征,建议在治疗中加入l-精氨酸以预防这种情况。2. 超声检查是评价PD治疗效果的可靠方法。
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引用次数: 0
Acute purulent widespread peritonitis: conceptual aspects of modern surgical tactics 急性化脓性广泛性腹膜炎:现代手术策略的概念方面
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-7-9
V. P. Andriushchenko
Background. The priority areas of the problem of acute widespread peritonitis (AWP) include the standardization of terminology and classification, assessment of the severity of the process, control of the infection source and correction of pathological intra-abdominal syndromes. Objective. To outline the conceptual aspects of AWP surgical treatment based on consensus guidelines and own research. Materials and methods. The study involved 371 patients with AWP. Patients underwent the necessary clinical, laboratory, biochemical, bacteriological, radiological, instrumental and pathomorphological studies. Results and discussion. To assess the severity of the disease one should assess the general clinical condition of the patient, the source and the site of infection, the presence or absence of organ or multiorgan dysfunction, the characteristics of the pathogen. The assessment of the clinical condition takes into account the patient’s age, physiological status and comorbid diseases, the general scales ASA, SOFA, APACHE, Marshall and peritonitis-specific scales (Mannheim Peritonitis Index, Peritonitis Index Altona). When determining the infection source, it is advisable to determine whether the process is provoked by damage to the upper or lower segment of the gastrointestinal tract. The most common causes of AWP in the own study were acute appendicitis (23 %), perforated gastric ulcer (21 %), acute pancreatitis and pancreatic necrosis (18 %). Acute cholecystitis, intestinal perforation, and anastomosis failure were somewhat less common. Suboperative measures during AWP surgery include detection and assessment of the source of the pathological process, elimination of the detected changes, lavage and adequate drainage of the abdominal cavity, correction of intra-abdominal pathological syndromes, clarification of the feasibility of programmed relaparotomy. Dekasan (“Yuria-Pharm”) is used for lavage. It is a local antiseptic, effective against gram-positive and gram-negative bacteria, viruses, and fungi. Dekasan is a surfactant that removes fibrin, pus, colonies of microorganisms and blood clots. According to V.V. Boiko et al. (2012), abdominal lavage with the help of Dekasan reduces postoperative mortality by almost 9 %, and the frequency of secondary purulent complications – by 16.5 %. Pathological intra-abdominal syndromes that need correction include abdominal compartment syndrome (ACS), intestinal insufficiency, and the excessive colonization of the proximal small intestine by pathological microflora. Prolonged tubal decompression of the small intestine, hyperbaric oxygenation, VAC-therapy, and application of negative pressure are used to decrease intra-abdominal hypertension in ACS. Tube techniques used in AWP include enteral lavage, enterosorption, selective pharmacological decontamination, and intraluminal transtubal electrophoresis. It is advisable to introduce enteral nutrition early. For additional detoxification and correction of water-elec
背景。急性广泛性腹膜炎(AWP)问题的重点领域包括术语和分类的标准化、过程严重程度的评估、感染源的控制和病理腹内综合征的纠正。目标。根据共识指南和自己的研究,概述AWP手术治疗的概念方面。材料和方法。该研究涉及371例AWP患者。患者接受了必要的临床、实验室、生化、细菌学、放射学、仪器学和病理形态学检查。结果和讨论。评估疾病的严重程度应评估患者的一般临床情况、感染的来源和部位、有无器官或多器官功能障碍、病原体的特征。临床状况的评估考虑了患者的年龄、生理状况、合并症、ASA、SOFA、APACHE、Marshall通用量表和腹膜炎特异性量表(Mannheim Peritonitis Index, Peritonitis Index Altona)。在确定感染源时,最好确定感染过程是由胃肠道上段损伤还是下段损伤引起的。在自己的研究中,AWP最常见的原因是急性阑尾炎(23%),胃溃疡穿孔(21%),急性胰腺炎和胰腺坏死(18%)。急性胆囊炎、肠穿孔和吻合失败较少见。AWP手术的亚手术措施包括发现和评估病理过程的来源,消除发现的变化,腹腔灌洗和充分引流,纠正腹腔内病理综合征,明确程序化再开腹手术的可行性。Dekasan(“Yuria-Pharm”)用于冲洗。它是一种局部防腐剂,对革兰氏阳性和革兰氏阴性细菌、病毒和真菌有效。Dekasan是一种表面活性剂,可以去除纤维蛋白、脓液、微生物菌落和血凝块。根据V.V. Boiko等人(2012)的研究,在Dekasan的帮助下进行腹部灌洗可使术后死亡率降低近9%,继发性化脓性并发症发生率降低16.5%。需要纠正的病理性腹腔内综合征包括腹腔隔室综合征(ACS)、肠道功能不全和病理性菌群对近端小肠的过度定植。延长小肠管减压、高压氧、vaca治疗和负压应用可用于降低ACS的腹腔内高血压。AWP中使用的管道技术包括肠内灌洗、肠吸收、选择性药理学净化和腔内经孔电泳。建议尽早引入肠内营养。对于额外的解毒和纠正水电解质平衡,使用高渗透压溶液(Reosorbilact,“Yuria-Pharm”)的小容量输注治疗。山梨糖醇含有山梨糖醇、乳酸钠和必要的离子。结论:1。解决AWP问题的现代方法应基于现代术语和分类原则,并提供对手术内容和抗生素治疗有效性的理解。2. 控制腹膜炎的来源包括彻底消除腹膜炎,对腹腔进行灌洗和引流,确保消化道的减压,实施输卵管计划措施。3.抗生素治疗和输液治疗是治疗的重要组成部分。4. 这些声明的实施将提高AWP治疗的有效性。
{"title":"Acute purulent widespread peritonitis: conceptual aspects of modern surgical tactics","authors":"V. P. Andriushchenko","doi":"10.32902/2663-0338-2020-3.2-7-9","DOIUrl":"https://doi.org/10.32902/2663-0338-2020-3.2-7-9","url":null,"abstract":"Background. The priority areas of the problem of acute widespread peritonitis (AWP) include the standardization of terminology and classification, assessment of the severity of the process, control of the infection source and correction of pathological intra-abdominal syndromes. \u0000Objective. To outline the conceptual aspects of AWP surgical treatment based on consensus guidelines and own research. \u0000Materials and methods. The study involved 371 patients with AWP. Patients underwent the necessary clinical, laboratory, biochemical, bacteriological, radiological, instrumental and pathomorphological studies. \u0000Results and discussion. To assess the severity of the disease one should assess the general clinical condition of the patient, the source and the site of infection, the presence or absence of organ or multiorgan dysfunction, the characteristics of the pathogen. The assessment of the clinical condition takes into account the patient’s age, physiological status and comorbid diseases, the general scales ASA, SOFA, APACHE, Marshall and peritonitis-specific scales (Mannheim Peritonitis Index, Peritonitis Index Altona). When determining the infection source, it is advisable to determine whether the process is provoked by damage to the upper or lower segment of the gastrointestinal tract. The most common causes of AWP in the own study were acute appendicitis (23 %), perforated gastric ulcer (21 %), acute pancreatitis and pancreatic necrosis (18 %). Acute cholecystitis, intestinal perforation, and anastomosis failure were somewhat less common. Suboperative measures during AWP surgery include detection and assessment of the source of the pathological process, elimination of the detected changes, lavage and adequate drainage of the abdominal cavity, correction of intra-abdominal pathological syndromes, clarification of the feasibility of programmed relaparotomy. Dekasan (“Yuria-Pharm”) is used for lavage. It is a local antiseptic, effective against gram-positive and gram-negative bacteria, viruses, and fungi. Dekasan is a surfactant that removes fibrin, pus, colonies of microorganisms and blood clots. According to V.V. Boiko et al. (2012), abdominal lavage with the help of Dekasan reduces postoperative mortality by almost 9 %, and the frequency of secondary purulent complications – by 16.5 %. Pathological intra-abdominal syndromes that need correction include abdominal compartment syndrome (ACS), intestinal insufficiency, and the excessive colonization of the proximal small intestine by pathological microflora. Prolonged tubal decompression of the small intestine, hyperbaric oxygenation, VAC-therapy, and application of negative pressure are used to decrease intra-abdominal hypertension in ACS. Tube techniques used in AWP include enteral lavage, enterosorption, selective pharmacological decontamination, and intraluminal transtubal electrophoresis. It is advisable to introduce enteral nutrition early. For additional detoxification and correction of water-elec","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77412641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safety and efficacy of the port-catheter systems during intensive intravenous chemotherapy in patients with multidrug-resistant tuberculosis and tuberculosis with extended resistance port-catheter系统在耐多药结核病和延长耐药结核病患者强化静脉化疗中的安全性和有效性
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-257-258
Y. Senko
Background. Yu-Port (“Yuria-Pharm”) is an implanted system for long-term infusions. This system allows multiple access to vessels for parenteral administration of drugs, fluids and nutrient solutions. Objective. To describe the safety and efficacy of the port-catheter systems during intensive intravenous chemotherapy in patients with multidrug-resistant tuberculosis (TB) and TB with extended resistance. Materials and methods. Analysis of the literature on this issue. Results and discussion. Prolonged venous access is required in case of long-term infusion therapy or chemotherapy, as well as with the use of drugs that irritate the veins. Routine methods of vascular access have a number of disadvantages: the needle of the system damages the vessel with each injection; infusion cannula should be replaced every 3-5 days; the central venous catheter cannot be installed permanently (on average, for 1 week). Therefore, port systems consisting of a titanium port and a vascular catheter have long been used for long-term venous access. When installing the port system, the catheter is in the vein, the port is under the skin, and the needle is brought out. The advantages of the Yu-Port system include a large silicone membrane, fluid flow rate of 5 ml/s, compatibility with magnetic resonance imaging, and the absence of latex and polyvinyl chloride. The Yu-Port package contains installation instructions and all the necessary tools. The silicone membrane allows repeated piercing only with a special Yu-Port needle or the included needle. After the puncture, the membrane is tightened, because due to a special sharpening needle does not tear the membrane material, but pushes it apart. Jugular or subclavian access is most often used to install ports. The advantages of using port systems in chemotherapy include low traumaticity, painless injections, no discomfort, ease of drug administration and blood sampling for analysis, lower risk of developing phlebitis, long use duration (several years). Our own experience with port systems (56 patients in 2019-2020) showed significantly fewer premature treatment terminations due to side effects than in the group of standard infusion therapy (12.50 % vs. 22.6 %). Conclusions. 1. Port systems consisting of a titanium port and a vascular catheter have long been used for long-term venous access. 2. The advantages of using port systems in chemotherapy include painless injections, no discomfort, ease of drug administration and blood sampling for analysis, lower risk of phlebitis, long use duration. 3. In patients who need long-term or multicomponent chemotherapy, for example, in multidrug-resistant TB, it is advisable to use port systems.
背景。豫港(“豫药”)是一种长期输液的植入系统。该系统允许多次进入血管进行药物、液体和营养液的肠外给药。目标。描述port-catheter系统在耐多药结核病(TB)和扩展耐药结核病患者强化静脉化疗中的安全性和有效性。材料和方法。对这一问题的文献进行分析。结果和讨论。在长期输液治疗或化疗的情况下,以及使用刺激静脉的药物时,需要延长静脉通路。常规的血管通路方法有许多缺点:每次注射时,系统的针头都会损坏血管;输液套管应每3-5天更换一次;中心静脉导管不能永久放置(平均放置1周)。因此,由钛金属端口和血管导管组成的端口系统一直被用于长期静脉通路。安装端口系统时,导管在静脉内,端口在皮肤下,针头被取出。Yu-Port系统的优点包括大硅胶膜,流体流速为5ml /s,与磁共振成像兼容,不含乳胶和聚氯乙烯。游戏端口包包含安装说明和所有必要的工具。硅胶膜允许重复穿孔只有用特殊的玉港针或包括针。穿刺后,膜被收紧,因为由于特殊的锐化针不会撕裂膜材料,而是将其推开。颈静脉或锁骨下通道最常用于安装端口。在化疗中使用port系统的优点包括创伤小,无痛注射,无不适,易于给药和抽血分析,发生静脉炎的风险较低,使用时间长(数年)。我们自己对port系统的经验(2019-2020年的56例患者)显示,由于副作用而过早终止治疗的人数明显少于标准输注治疗组(12.50%对22.6%)。结论:1。端口系统由钛端口和血管导管组成,长期用于长期静脉通路。2. 在化疗中使用port系统的优点包括无痛注射、无不适、易于给药和抽血分析、静脉炎风险低、使用时间长。3.对于需要长期或多组分化疗的患者,例如耐多药结核病患者,建议使用port系统。
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引用次数: 0
Premature rupture of the amniotic membrane: what’s new in its management and delivery tactics? 羊膜早破:在处理和分娩策略上有什么新进展?
Pub Date : 2020-12-15 DOI: 10.32902/2663-0338-2020-3.2-314-316
S. B. Chechuga
Background. Premature rupture of the amniotic membranes (PRAM) is a spontaneous rupture before the onset of labor at 22-37 weeks. The main complications of PRAM for mother and fetus include infection, premature birth, asphyxia of the fetus during labor, and the increased frequency of cesarean sections. Deformations of extremities, face and lungs are observed in case of a long oligohydramnion (>3 weeks). Objective. To describe the features of the management of pregnant women with PRAM. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Gynecological and extragenital pathology of mother, genetic predisposition, adverse environmental factors and infections are risk factors for PRAM. Prevention of PRAM includes detection and treatment of urogenital infections, quitting of smoking and alcohol intake, screening for bacteriuria and bacteriological culture for β-hemolytic streptococcus (BHS) at 35-37 weeks of pregnancy. From 22 to 34 weeks of pregnancy, pregnant women with PRAM are hospitalized to the tertiary level hospitals, since 35 weeks care can be provided in secondary level hospitals. The management algorithm is the following: 1) history taking; 2) establishment of gestational age; 3) establishment of the approximate time of PRAM; 4) general physical examination; 5) external obstetric examination; 6) cardiotocogram (CTG), tests of fetal movements (TFM), ultrasonography (US); 7) blood test with leukocyte formula, determination of C-reactive protein; 8) bacterioscopic examination of vaginal discharge; 9) collection of amniotic fluid for microbiological examination, study of rectogenital smear for BHS; 10) sanitation of the vagina with a solution of antiseptic decamethoxine after collection of vaginal secretions and amniotic fluid. PRAM management involves active or waiting tactics. Waiting tactic includes monitoring of the fetus and mother (thermometry and pulsometry, the number of leukocytes and C-reactive protein, bacterioscopy of vaginal discharge, CTG, TFM, US). Antibiotic prophylaxis (semi-synthetic penicillins + macrolides, reserve – second-generation cephalosporins) in PRAM significantly prolongs the latent phase of delivery, reduces the incidence of infections in both mother and newborn, reduces the need for surfactant and oxygen therapy. In the presence of chorioamnionitis, delivery should be performed within <12 hours. In case of PRAM in the term of 24-34 weeks the course of corticosteroids is administered. Delivery delay for 48 h for steroid prophylaxis is the main indication for tocolysis in PRAM. In general, the tactics of pregnancy management in PRAM at 24-34 weeks include monitoring of the mother and fetus, steroid prophylaxis, tocolytic therapy and the use of magnesium sulfate. Waiting tactic should be followed until 34 weeks. In women with PRAM without contraindications to prolonging pregnancy, the waiting tactic is accompanied by better results for both mother and fetus. Signs of infecti
背景。羊膜早破(PRAM)是在22-37周分娩前发生的自发性破裂。PRAM对母亲和胎儿的主要并发症包括感染、早产、分娩时胎儿窒息和剖宫产的增加。长时间羊水过少(>3周)可导致四肢、面部和肺部变形。目标。目的:探讨PRAM孕妇的处理特点。材料和方法。对这一主题的文献来源进行分析。结果和讨论。母亲的妇科和外阴病理、遗传易感性、不良环境因素和感染是PRAM的危险因素。预防PRAM包括检测和治疗泌尿生殖系统感染,戒烟和戒酒,在怀孕35-37周进行细菌尿筛查和β-溶血性链球菌(BHS)的细菌培养。从怀孕22至34周,患有PRAM的孕妇在三级医院住院,因为在二级医院可以提供35周的护理。管理算法如下:1)取历史;2)胎龄的确定;3) PRAM近似时间的建立;4)全身检查;5)产科外检;6)心图(CTG)、胎动试验(TFM)、超声(US);7)血检用白细胞配方,测定c反应蛋白;8)阴道分泌物细菌学检查;9)采集羊水进行微生物学检查,直肠生殖器涂片检查BHS;10)收集阴道分泌物和羊水后,用十甲氧辛消毒液消毒阴道。PRAM管理包括主动或等待策略。等待策略包括对胎儿和母亲进行监测(测温、测脉、白细胞和c反应蛋白数量、阴道分泌物细菌学检查、CTG、TFM、US)。在PRAM中预防使用抗生素(半合成青霉素+大环内酯类,储备第二代头孢菌素)可显著延长分娩潜伏期,降低母亲和新生儿感染的发生率,减少表面活性剂和氧治疗的需要。如果存在绒毛膜羊膜炎,分娩应在<12小时内进行。如果在24-34周期间出现PRAM,则给予皮质类固醇疗程。分娩延迟48小时用于类固醇预防是主要指征在PRAM的胎溶。一般来说,PRAM 24-34周的妊娠管理策略包括监测母胎、类固醇预防、溶栓治疗和使用硫酸镁。应采取等待策略,直到34周。在无延长妊娠禁忌症的PRAM妇女中,等待策略对母亲和胎儿都有更好的结果。感染或其他妊娠并发症的迹象表明需要根据临床情况终止等待策略和分娩管理。在34-37周内,采用24小时的等待策略。抗生素预防在无水间隔18小时后开处方,在BHS的情况下-在PRAM后立即开处方。在没有主动分娩过程的情况下,进行内部产科检查以决定分娩策略。其他程序包括宫颈准备、引产和用十胺甲素溶液清洗阴道。在26-32周的PRAM和产道不成熟时,应进行剖宫产。结论:1。患有PRAM的妇女在二级和三级医院住院和分娩。2. 在PRAM中常规使用抗生素可延长分娩潜伏期,减少新生儿败血症的发生率。3.在24-34周的PRAM孕妇中,等待策略对母亲和孩子都有良好的结果。4. 24-34周PRAM孕妇应给予皮质类固醇治疗,以预防新生儿急性呼吸窘迫综合征。
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Infusion & Chemotherapy
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