Применение углеродных сорбентов при критических состояниях организма

Abstract

Many modern sorbents have low sorption activity toward toxic substances of protein nature. Sorption selectivity for protein compounds can be enhanced by chemical modification of the sorbent surface withpolyvinylpyrrolidone. At the first stage of the study, 58 patients after surgical removal of abdominal cavity tumors were examined and treated. In 28 patients, the postoperative period was complicated with diffuse purulent peritonitis. So, the complex therapy of these patients was supplemented with 1-2 hemosorption sessions using a VNIITU-1 carbon sorbent in a sterile saline solution. The sorbent, which was awarded with a gold medal of the International Salon of Innovations and In-vestments, has a meso-porous surface that allows toxic substances of low and moderate molecular weight to be removed from the human body. The hemosorption sessions substantially reduced hematological, immunological and biochemical disorders and ultimately decreased mortality in the early postoperative period by a factor of 3.7. The second stage of the study was aimed to develop a molded carbon sorbent based on VNIITU-1 for selective sorption of pro-inflammatory cytokines form blood plasma. Bench testing was performed with blood plasma obtained during plasmapheresis from 15 patients with acute pancreatitis complicated with pancreonecrosis and diffuse purulent peritonitis. Blood plasma perfusion was carried out on a Unirol-1 device using the 10 cm3 columns filled with the sorbent, at a rate of 15 ml/min and a plasma/sorbent ratio of 10/1. Overall, 50 ml of plasma was passed through the column. The TNFɑ, IL-1β, IL-4, and IgA contents were determined in blood plasma before and after the sorption. The modified hemosorbent VNIITU-1-PVP showed much higher sorption capacity and selectivity than the initial VNIITU-1. This concerns pro-inflammatory cytokine interleukin-1β: its concentration decreased by a factor of 33.5 and TNF-α was virtually absent. The level of anti-inflammatory cytokine interleukin-4 was nearly twofold higher as compared to blood plasma that was passed through VNIITU-1. The IgA content remained virtually unchanged.