Boyarinov G A, Zubeyev P S, Mokrov K V, Voyennov O V
Professor, Head of the Department of Anesthesiology and Resuscitation, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
Professor, Head of the Department of Emergency Medical Care, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
Sovrem Tekhnologii Med. 2020;12(1):105-121. doi: 10.17691/stm2020.12.1.14.
Questions regarding the application of extracorporeal detoxification to patients with severe acute pancreatitis have been considered. Hemodialysis, the historically first method of extracorporeal detoxification for such patients, has been also described in the review. Appropriateness of using renal replacement therapy methods and among them continued renal replacement therapy has been shown. Hemofiltration and hemodiafiltration technologies are described in detail including different modes of their application and the possibility of using various types of filters. Available data on hemofiltration for patients with severe acute pancreatitis have been analyzed. Great attention is paid to the unsolved aspects of hemofiltration in severe acute pancreatitis such as determining renal and extrarenal indices; time of starting hemofiltration; selection of volume replacement modes and a buffer system; procedure duration; anticoagulation measures, defining criteria to assess the adequacy of hemofiltration, state severity, and organ dysfunction degree. Further multicenter investigations are necessary to be able to assess the efficacy of the hemofiltration procedures on the basis of the thoroughly worked out and pathogenically grounded protocol using adequate control methods taking into consideration endogenic intoxication phases and intensity of the multiple organ failure syndrome.
已对体外解毒应用于重症急性胰腺炎患者的相关问题进行了探讨。血液透析是历史上针对此类患者的第一种体外解毒方法，该综述中也有相关描述。已证明使用肾脏替代治疗方法的合理性，其中包括持续肾脏替代治疗。详细描述了血液滤过和血液透析滤过技术，包括其不同的应用模式以及使用各种类型滤器的可能性。已分析了有关重症急性胰腺炎患者血液滤过的现有数据。重点关注了重症急性胰腺炎血液滤过中尚未解决的问题，如确定肾脏和肾外指标；开始血液滤过的时间；容量替代模式和缓冲系统的选择；治疗持续时间；抗凝措施，确定评估血液滤过充分性、病情严重程度和器官功能障碍程度的标准。有必要进行进一步的多中心研究，以便能够根据经过充分制定且基于发病机制的方案，使用适当的对照方法，并考虑内源性中毒阶段和多器官功能障碍综合征的强度，来评估血液滤过程序的疗效。
