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Том 20 №4 2018 год - Нефрология и диализ

Терапевтический плазмообмен в интенсивной терапии и интенсивной нефрологии


Ветшева М.С. Лосс К.Э. Подкорытова О.Л. Лебедьков Е.В. Столбова И.А. Назарова И.Н. Ткаченко Н.Я. Тарнопольский Р.А. Яковлева И.И.

DOI: 10.28996/2618-9801-2018-4-394-403

Аннотация: Терапевтический плазмообмен (ПО) - это процедура, которая представляет собой процесс удаления большого объема плазмы с последующим замещением, при этом происходит удаление различных биологически активных веществ, которые оказывают патологическое воздействие на организм пациента. Плазмообмен при некоторых заболеваниях является одним из звеньев патогенетической терапии (АНКА-ассоциированный системный васкулит, антифосфолипидный синдром, синдром Гудпасчера, тромботическая микроангиопатия и др.), удаляя циркулирующие иммунные комплексы, повреждающие ткани и органы-мишени, восстанавливает нарушенную систему свертывания крови. В 2016 году вышли последние практические рекомендации американского общества афереза, в котором ведущие специалисты в области аферезной терапии на основании анализа многочисленных клинических исследований, дают врачам всех специальностей, занимающихся экстракорпоральной детоксикацией, четкие рекомендации по применению аферезных технологий. Также разработаны 4 категории показаний и противопоказаний, оценивающих пользу проведения процедур афереза для конкретной нозологии. Внесен ряд новых заболеваний, таких как атопический (нейро) дерматит (атопическая экзема), кардиальная неонатальная волчанка, энцефалопатия Хашимото, HELLP синдром, при которых ПО является одним из ведущих лечебных мероприятий наряду с цитостатической и глюкокортикостероидой терапией. Однако остается ряд заболеваний, при котором использование ПО остается спорным, как например сепсис, это заставляет проводить дальнейшие исследования в этом направлении.

Весь текст

Ключевые слова: терапевтический плазмообмен, аутоантитела, иммуноглобулины, факторы свертывания, сепсис, полиорганная недостаточность, therapeutic plasma exchange, autoantibodies, immunoglobulins, coagulation factors, sepsis, multiorgan failure

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