Clinical example of hemofiltration in rheumatism. Ultrafiltration of blood in heart failure

The high mass fraction of water in plasma (serum) limits the possibility of its use in the production of certain types of meat products. A promising method for reducing the mass fraction of moisture is ultrafiltration through semipermeable membranes. Which allow water and low molecular weight substances to pass through, and macromolecules are retained. This leads to an increase in the concentration of high molecular weight components of the mixture. The driving force is the pressure gradient. The separation is carried out at room temperature, which contributes to the preservation of the native properties of the protein.

By the method of ultrafiltration, the mass fraction of proteins in the plasma (serum) of the blood can be brought up to 20%. The combination of ultrafiltration with drying provides a reduction in energy costs and a high quality product.

Skin processing

Skin processing technology

Skin is called skin with hairline. Skins in their structure and properties differ depending on the type of animal, their sex and age. The skin consists of three main layers: epidermis, dermis and subcutaneous tissue.

Skins freshly removed from animal carcasses are called pair skins. Under the action of microorganisms and enzymes quickly deteriorate. Microbes (spore, cocci, putrefactive) penetrate into the subcutaneous tissue, the mucous layer of the epidermis, hair follicles and glands and multiply rapidly there. At a deeper stage, the epidermis exfoliates, hair is separated, a strong smell of ammonia and hydrogen sulfide is felt. The dermis becomes flabby, dark, slimy and fragile. Under unfavorable conditions for keeping livestock, piles (dung + mud) form on the skins. After shooting, cuts of muscle and adipose tissue remain on the skins, blood clots are weighting agents. They create conditions for the development of microflora. Therefore, they should be removed. This is also necessary to determine the so-called pair weight of skins, according to which the meat processing plant pays off with the leather industry. Skins are delivered to tanneries in a fresh or canned state.

Processing or preservation of skins must be done no later than 3 hours after skinning. In such a period they do not have time to transport over long distances. Therefore, the bulk of the skins are preserved. The preparation of paired skins for delivery to the leather industry is carried out according to the following operations: removal of bulk, cuts of meat and subcutaneous tissue from the mezdrya side, washing, contouring, sorting, including determining their weight and area.

Bulk Removal: to facilitate the removal of pile and avoid damage to the front layer, the pile is pre-moistened by irrigating the woolly side of the skin with water from a hose or from a shower for 1 min. Moistened skins are kept in a pile until the bulk is completely softened, but not more than 1 hour. Then they are freed from bulk on a bulk machine or manually.

Flushing. Cattle skins without bulk are washed with cold water to cool them, remove dirt and blood. Together with them, part of the microbes and part of the soluble proteins are removed. Rinsing is carried out under a shower or from a hose (it is possible in a drum). Excess water is removed by draining for no more than 1 hour. The skins of pigs and small cattle are not washed.

Mezdrenie. Removal of muscle and adipose tissue, as well as part of the subcutaneous tissue - the mezra. Skinning allows you to save cuts and skins for use for food and technical purposes, and also helps to accelerate the diffusion of salt into the skin during salting and reduce the mass of raw materials (up to 15%), which is important for its further use, transportation and storage. Large cuts are used for food purposes. The remaining cuts and skins are used to produce technical fat and fodder meal.

contouring. The skins after shooting have a complex sinuous contour. Their marginal sections (heads, paws) are torn off during mechanical processing at meat processing plants and tanneries, forming low-value waste. At the same time, along with them, the adjacent ones useful for cutting (16% of the waste from the mass of raw materials) also go to waste. To reduce waste in the production of leather, the contours are aligned or contoured. It increases the degree of utilization of raw hides and finished hides. When cutting them in the shoe industry. And also allows you to additionally obtain protein raw materials that can be used for food and feed purposes. The removed sections of cattle skins make up 12% of their mass, they separate the frontal part of the skin with eye holes, the ends of the front and hind legs. When shooting skins from pig carcasses, croupon acts as a contoured raw material using the crouponing method.

According to the new technology, when contouring, skins are completely filmed and skinned, after which a larger croupon is cut out (65-70% of the total area, 34-38% more than usual). The rest of the skin is used for food purposes, i.e. production of protein stabilizer, edible gelatin, crispy slices, etc. New technology, significantly improves the grade of skins.

Sorting. Natural features, the presence of defects (during life and production), weight, area, condition of the skins determine the quality of the skins and furs made from them. The skins are examined from the skin and wool sides, the mass is determined, and the area of the MRS is determined. In MRS skins, wool is additionally determined. The area of the skin is determined in a straightened form using a decimeter board or planimeter.

Canning skins

Canning. Should not cause significant changes in collagen, since the quality of the skin and fur depends on its properties and condition. The degree of hydration of a canned skin after soaking it approaches the degree of hydration of a fresh skin. Taking into account these requirements, various methods of preservation are used: for short-term and long-term storage.

Canning for short-term storage carried out by physical and chemical methods. In recent years, there has been a tendency to reduce or completely eliminate table salt for canning leather or skins and furs. Most often, preservation is carried out using antiseptics. This guarantees the preservation of skins from 2 days to several weeks without deterioration in quality. Antiseptics should be readily soluble in water, not have an unpleasant odor, not have a negative effect on the process of leather dressing, be relatively harmless to the attendants, not in short supply and inexpensive. to antiseptics. used for short-term preservation include ammonium salts, hypochlorite, its mixture with boric acid, a solution containing 1% sodium sulfate and 1-3% acetic acid, fluorides, sulfates, zinc salts, reducing agents such as sodium bisulfite and sulfur dioxide formed from it, a solution dimethyl sulfide + phenol, surfactants, HOURS, as well as antiseptics with the largest amount of sodium chloride. For example, a mixture of 5% (relative to the mass of the skin) salt and 0.5-1% antiseptic provides storage of skins for 21 days. The solution is sprayed onto or dipped into the hide, or the hide is treated with the solution in a drum. To control the treatment of the entire surface, a non-toxic solvent soluble in water is introduced into the solution. The cost of short-term conservation with antiseptics is about I0 times less than usual. With such conservation, the skins are practically not dehydrated and retain their native structure, but the connection between the hair and the skin tissue may be weakened.

Method of short-term preservation by brine raw hide without subsequent salting allows to reduce the consumption of table salt by 10-15%. It is recommended to add sodium silicofluoride 0.75-1 g to brine, which guarantees the storage of raw hides for 7 days

Cold preservation occurs due to braking autolytic and bacterial processes. The skins after shooting are cooled in a tunnel at a temperature of -1 ºС for 20 minutes. The temperature of the skins is reduced to 2 ºС. After that, they can be stored in stacks for up to 3 weeks.

Preservation of skins intended for long-term storage produced in spreading by dry preservation and brine (in saturated solution): at sufficiently high concentrations, it delays microbial spoilage. A 10-15% solution prevents most putrefactive microbes from developing. Some microbes can even grow on dry salt (halophilic). That. salt itself can be a source of contamination of brines with undesirable microflora and cause damage to skins, especially if they are stored in unfavorable conditions. The skin is considered preserved if the salt content in it is at least 12%, and the moisture content is not more than 48%.

The duration of the process depends on the properties of the raw material: structure, permeability, as well as thickness. Even a slight decrease in the thickness of the skin leads to a significant reduction in the duration of the salting. Therefore, the removal of subcutaneous tissue, the skinning of skins contributes to the acceleration of canning.

Canning in Raised Salt: A layer of salt is poured onto the rack, 20-50 mm thick, the skins are laid with the skin side up and, sprinkling them with salt, form a stack 1.5-2 m high. Salt consumption for salting is 35-50% by weight of raw materials. Salting is 13% by weight of paired skins. The duration of curing for cattle and pig skins is 6-7 days, for sheepskins at least 4 days, for rabbits - 2 days. Temperature \u003d 18-20 ºС. Compositions based on table salt with the use of antiseptics enhance its preservative effect. As antiseptics, sodium fluorosilicon, paradichlorobenzene, naphthalene are used, which is added to brine at the rate of 2.4 - 10 kg per 1 ton of leather or fur coats. Compositions with a reduced amount of table salt are obtained on the basis of dehydrating and inorganic salts and organic compounds. Sheepskins are treated with a mixture of common salt, potassium alum and ammonium chloride - This is an acidic preservation method.

In this case, there is a rapid and significant dehydration of sheepskins, a shift in pH to the acid side, slight pickling (acid treatment under the action of sulfuric and hydrochloric acids) arising from the hydrolysis of alum and ammonium chloride, as well as partial tanning with aluminum ions. Sheepskins preserved in this way are more resistant to the action of microbes and enzymes, in conditions of elevated temperatures and humidity. Sheepskin processing time is 4-7 days, fur and fur coats must contain 38-42% water, pH 4-4.5 and shrinkage 4%.

Dry salted preservation:

Sheepskins and rabbit skins are first salted for 6 hours, and then dried for 16-18 hours at T = 20-30 ºС. Sheepskin shrinkage - 30%, area shrinkage - 6%, humidity 18-20%.

Fresh-dry preservation:

Preservation of sheepskins and calf skins in this way consists in dehydration of the skins without treatment with preservatives and substances. Drying mode, as in the dry-salted method. Shrinkage -60%, shrinkage-10%.

Defect of leather raw materials

Skin defects are divided into lifetime and technological. Lifetime vices due to the peculiarities of the structure of the skin, resulting from skin diseases, technological - insufficient feeding, poor livestock management, damage during shooting, conservation and storage. Lifetime defects of skins include: borosity (thickened rough folds on the collar of the skin of uncastrated bulls), fistula (damage to the skin by gadfly larvae), facelessness (absence of the front layer of the skin in some areas as a result of mechanical damage), prickly peg (through punctures of the skins of sheep and goats with prickly grass). Defects arising during the shooting and rite of the skins - the wrong cut of the skin, undercuts, holes, etc. Defects during conservation and storage are associated with a delay in conservation, uneven distribution of the preservative, etc.

Questions for self-control

1. What are the requirements for the blood processing process.

2. Tell us about canning skins of m.r.s.

3. Tell us about canning pig skins.

4. Tell us about canning k.r.s. skins.

5. What are the main operations for processing skins of k.r.s.

6. What operations are carried out before canning skins?

7. What canning methods do you know?

8. What preservatives and antiseptics are used when preserving skins?

9. Name the defects of the skins. Causes of their occurrence and ways to eliminate them.

10. What is the purpose of skin contouring?

BIBLIOGRAPHY

a) basic literature (SSAU library)

1. Pronin, V.V. Technology of primary processing of livestock products / V.V. Pronin, S.P. Fomenko, I.A. Mazilkin. - "Lan", 2013. - 176 p. ISBN: 978-5-8114-1312-6

2. Rogov, I.A. Technology of meat and meat products [Text]: textbook. Book. 1: General technology of meat / I. A. Rogov, A. G. Zabashta, G. P. Kazyulin. - M.: KolosS, 2009. - 565 p. - ISBN 978-5-9532-0538-2

2. Rogov, I.A. Technology of meat and meat products [Text]: textbook. Book. 2: Technology of meat products / I. A. Rogov, A. G. Zabashta, G. P. Kazyulin. - M.: KolosS, 2009. - 711 p. - ISBN 978-5-9532-0538-2

Ultrafiltration I Ultrafiltration

a method for correcting water homeostasis with excess water in the body by removing protein-free fluid from the blood through natural or artificial membranes that play the role of an ultrafilter. Most often, the peritoneum, artificial dialysis and hemofiltration membranes are used as an ultrafilter. The source of ultrafiltrate formation is mainly extracellular fluid entering the bloodstream under the action of oncotic pressure of plasma proteins. Unlike diuretics, ultrafiltration allows for dosed dehydration with little effect on the electrolyte composition and acid-base state of the blood. With the simultaneous removal of a large amount of fluid (several liters), a tendency to hyperkalemia, metabolic acidosis, an increase in hematocrit and blood viscosity, and an accelerated increase in azotemia develops.

Ultrafiltration of fluid in the blood is achieved by creating a pressure difference on both sides of the filtration membrane: osmotic or hydrostatic. Accordingly, osmotic and hydrostatic W are distinguished.

Osmotic U. is usually carried out during peritoneal dialysis. To obtain the effects, it is necessary that the dialysate solution be higher than the osmotic pressure of the blood. Glucose is mainly used as an osmotically active substance, adding it to 1 l isotonic salt solution in the amount of 15, 25 or 42.5 g/l, that, when the solution is injected into the abdominal cavity, it makes it possible to obtain, respectively, 200, 400 or 800 ml ultrafiltrate. After 4-6 h when the difference between the osmotic pressure of the blood and the solution disappears, all fluid from the abdominal cavity is removed. Selecting for dialysis with a certain concentration of glucose, regulate the water content in the patient's body.

Hydrostatic U. is usually carried out with the help of a dialyzer, on the membrane of which a positive difference is created between the blood pressure and the hydrostatic pressure of the dialysis solution. the value of this difference, called the transmembrane pressure, as well as the permeability of the membrane for the ultrafiltrate depends on the rate of ultrafiltration. The permeability coefficient is expressed by the amount of ultrafiltrate (in ml) passing through the membrane in 1 h for each mmHg st. transmembrane pressure. According to the value of this coefficient, all manufactured dialyzers are small (2-3 ml/mmHg st. in 1 h), medium (4-6 ml/mmHg st. in 1 h) and large (8-12 ml/mmHg st. in 1 h) permeability. The design of the devices allows you to set the required U. mode according to the selected transmembrane pressure. By subtracting from the latter the blood pressure measured by the direct method in the venous bubble chamber, the pressure of the solution on the outside of the membrane is determined, which is necessary to obtain the required ultrafiltration rate. The pressure of the solution in the apparatus is controlled manually or automatically according to the set transmembrane pressure. There are devices in which the control of U. is carried out on the principle of volumemetry or electromagnetic flowmetry. The limiting value of the transmembrane pressure should not reach the bursting pressure (approximately 600 mmHg st.).

Ultrafiltration at speeds from 5 to 35 ml/min eliminates a fairly significant fluid retention for several hours. With some variants of the method, for example, with the help of constant spontaneous (due to blood pressure) arteriovenous U., for 1 day. can be removed from the body if necessary 15-20 l liquids, completely eliminating edema.

In patients with heart failure, U. effectively reduces the central volume and central blood, restoring the heart and eliminating ventilation and gas exchange disorders. In patients with uremia, the combination of hemodialysis with large U., which is usually combined with fluid replacement infusion, improves the quality of blood purification (primarily from substances of medium molecular weight) and accelerates the regression of many of the dangerous symptoms of uremia.

Indications for urgent use of U. are pulmonary edema of any etiology, as well as cerebral edema that develops in connection with acute water stress. Along with other methods, U. is used in the complex treatment of patients with anasarca, with edema due to congestive heart failure (especially in the presence of resistance to diuretics and glycosides) or nephrotic syndrome without renal failure, with fluid retention in the body after surgery with cardiopulmonary bypass and hemodilution. In addition, U. is an integral part of the program of hemodialysis treatment of patients with renal insufficiency, in which fluid is retained due to oliguria. Sequential use of U. and hemodialysis in such patients is advisable only in cases where their joint implementation creates a threat of development .

Ultrafiltration is carried out only in a hospital. The procedure is performed in the position of the patient on a functional bed. Before the start of the procedure, the patient is administered at a dose of 15-30 per 1 kg body weight to prevent blood clotting at the time of filling the dialyzer; in the process of ultrafiltration, a constant infusion of heparin is carried out at a rate of 10-15 units per 1 kg body weight per hour. Throughout the procedure, the ultrafiltration mode is controlled; if necessary, with the help of special devices, its speed is regulated and the patient's fluid balance is maintained. The effectiveness of the procedure is assessed by the amount of fluid removed, the decrease in the patient's body weight, and the regression of symptoms of overhydration. Particular attention is paid to the dynamics of the filling of the jugular veins, the frequency of pulse and respiration, peripheral edema, ascites, hydrothorax, hydropericardium, liver size, wet rales in the lungs, discoloration of the blood in the extracorporeal system. For an objective characterization of the effectiveness of treatment, in some cases, repeated chest radiography is performed, the dynamics of central venous pressure, volumes of circulating plasma and extracellular fluid are noted. After W. is almost always observed.

Complications in the process of U. can be hypovolemia, in the muscles of the legs and arms, spastic pain in the abdomen and chest, hoarseness,. In the case of severe hypovolemia, it can develop with loss of consciousness, generalized convulsions and respiratory arrest. It should be borne in mind that severe collapse is rarely the result of an error during U., rather, it can be a manifestation of sudden onset of internal bleeding, cardiac tamponade, myocardial infarction, bacterial shock, adrenal insufficiency. The threat of collapse increases during U. in patients receiving β-blockers and. Treatment of emerging complications is carried out immediately. Muscle cramps that occurred before reaching the desired result U. are stopped without interrupting the procedure with infusions of 60-80 ml 40% glucose solution, 20 ml 10% calcium gluconate solution, 20-40 ml 10% sodium chloride solution. in arterial hypotension is to timely lower the head end of the bed below the horizontal level, reduce the speed or stop ultrafiltration, slow down arteriovenous blood perfusion. Then, based on the situation, an infusion of 500 ml 5% glucose solution, prepared on a polyionic basis (easier to perform through the arterial line of the dialysis system using a pump); if necessary, enter 200 ml 20% albumin solution, 30-60 mg prednisolone, returned from the apparatus.

II Ultrafiltration (Ultra + filtration ())

the process of filtration through biological or artificial semi-permeable membranes; such as the formation of primary urine.

Capillary ultrafiltration- U. blood plasma or tissue fluid through the wall of the blood capillary, which occurs under the influence of the difference in tissue osmotic pressure and the sum of osmotic and hydrostatic pressure in the lumen of the capillary; provides passage through the wall of the blood capillary of water and other compounds of small molecular weight.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

Synonyms:

See what "Ultrafiltration" is in other dictionaries:

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ULTRAFILTRATION- ULTRAFILTRATION, separation of the dispersion medium from the dispersed phase of the sol by filtering the latter under increased pressure through a sealed filter. For the first time, W. used Malfitano (Malfrtano, 1904). Behgold (Beohhold), the term was introduced to the Crimea ... ... Big Medical Encyclopedia

Separation of solutions and colloidal systems with the help of semi-permeable membranes in special apparatuses under pressure of 0.1-0.8 MPa. It is used to treat wastewater, blood, vaccines, fruit juices, etc… Big Encyclopedic Dictionary

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Ultrafiltration- a method for correcting water homeostasis with excess water in the body by removing protein-free fluid from the blood through natural or artificial membranes that play the role of an ultrafilter. Most often, the peritoneum, artificial dialysis and hemofiltration membranes are used as an ultrafilter. The source of ultrafiltrate formation is mainly extracellular fluid entering the bloodstream under the action of oncotic pressure of plasma proteins. Unlike diuretics, ultrafiltration allows dosed dehydration with little effect on the electrolyte composition and acid-base state of the blood. With the simultaneous removal of a large amount of fluid (several liters), a tendency to hyperkalemia, metabolic acidosis, an increase in hematocrit and blood viscosity, and an accelerated increase in azotemia develops.

Osmotic U. is usually carried out during peritoneal dialysis. To obtain the effects, it is necessary that the osmotic pressure of the dialysis solution be higher than the osmotic pressure of the blood. Glucose is mainly used as an osmotically active substance, adding it to 1 l isotonic salt solution in the amount of 15, 25 or 42.5 g/l, that, when the solution is injected into the abdominal cavity, it makes it possible to obtain, respectively, 200, 400 or 800 ml ultrafiltrate. After 4-6 h when the difference between the osmotic pressure of the blood and the solution disappears, all fluid from the abdominal cavity is removed. Selecting dialysis solutions with a certain concentration of glucose, regulate the water content in the patient's body.

Hydrostatic U. is usually carried out with the help of a dialyzer, on the membrane of which a positive difference is created between the blood pressure and the hydrostatic pressure of the dialysis solution. The rate of ultrafiltration depends on the magnitude of this difference, called the transmembrane pressure, as well as on the permeability coefficient of the membrane for the ultrafiltrate. The permeability coefficient is expressed by the amount of ultrafiltrate (in ml) passing through the membrane in 1 h for each mmHg st. transmembrane pressure. According to the value of this coefficient, all manufactured dialyzers are small (2-3 ml/mmHg st. in 1 h), medium (4-6 ml/mmHg st. in 1 h) and large (8-12 ml/mmHg st. in 1 h) permeability. The design of the devices allows you to set the required U. mode according to the selected transmembrane pressure. By subtracting from the latter the blood pressure measured by the direct method in the venous bubble chamber, the pressure of the solution on the outside of the membrane is determined, which is necessary to obtain the required ultrafiltration rate. The pressure of the solution in the apparatus is controlled manually or automatically according to the set transmembrane pressure. There are devices in which the management and control of U. are carried out on the principle of volumemetry or electromagnetic flowmetry. The limiting value of the transmembrane pressure should not reach the bursting pressure (approximately 600 mmHg st.).

In patients with heart failure, U. effectively reduces the central volume and central venous blood pressure, restoring the working capacity of the heart and eliminating ventilation and gas exchange disorders. In patients with uremia, the combination of hemodialysis with large U., which is usually combined with fluid replacement infusion, improves the quality of blood purification (primarily from substances of medium molecular weight) and accelerates the regression of many of the dangerous symptoms of uremia.

Contraindications to the use of the method are hypovolemia, arterial hypotension, hyperkalemia, metabolic acidosis, intoxication with cardiac glycosides, adrenal insufficiency.

Ultrafiltration is carried out only in a hospital. The procedure is performed in the position of the patient on a functional bed. Before the start of the procedure, the patient is administered heparin at a dose of 15-30 IU per 1 kg body weight to prevent blood clotting at the time of filling the dialyzer; in the process of ultrafiltration, a constant infusion of heparin is carried out at a rate of 10-15 units per 1 kg body weight per hour. Throughout the procedure, the ultrafiltration mode is controlled; if necessary, with the help of special devices, its speed is regulated and the patient's fluid balance is maintained. The effectiveness of the procedure is assessed by the amount of fluid removed, the decrease in the patient's body weight, and the regression of symptoms of overhydration. Particular attention is paid to the dynamics of the filling of the jugular veins, the frequency of pulse and respiration, peripheral edema, ascites, hydrothorax, hydropericardium, liver size, wet rales in the lungs, discoloration of the blood in the extracorporeal system. For an objective characterization of the effectiveness of treatment, in some cases, repeated chest radiography is performed, the dynamics of central venous pressure, volumes of circulating plasma and extracellular fluid are noted. After U., oliguria is almost always observed.

Hypovolemia, cramps in the muscles of the legs and arms, spastic pains in the abdomen and chest, hoarseness, and vomiting can be complications during U.'s conduct. In the case of severe hypovolemia, collapse may develop with loss of consciousness, generalized convulsions and respiratory arrest. It should be borne in mind that severe collapse is rarely the result of an error during U., rather, it can be a manifestation of sudden onset of internal bleeding, cardiac tamponade, myocardial infarction, bacterial shock, adrenal insufficiency. The threat of collapse increases during U. in patients receiving b-adrenergic blockers and antihypertensive drugs. Treatment of emerging complications is carried out immediately. Muscle cramps that occurred before reaching the desired result U. are stopped without interrupting the procedure with infusions of 60-80 ml 40% glucose solution, 20 ml 10% calcium gluconate solution, 20-40 ml 10% sodium chloride solution. First aid for arterial hypotension is to timely lower the head end of the bed below the horizontal level, reduce the speed or stop ultrafiltration, slow down arteriovenous blood perfusion. Then, based on the situation, an infusion of 500 ml 5% glucose solution, prepared on a polyionic basis (easier to perform through the arterial line of the dialysis system using a pump); if necessary, enter 200 ml 20% albumin solution, 30-60 mg prednisolone, return blood from the apparatus.

SUBSTANCE: invention relates to medicine, cardiac surgery, methods of blood ultrafiltration under cardiopulmonary bypass. Blood ultrafiltration is carried out under conditions of cardiopulmonary bypass by placing the inlet line of the ultrafilter into the arterial line of the cardiopulmonary bypass circuit, and the outlet line of the ultrafilter is placed into the cannula of the inferior vena cava. EFFECT: invention helps to reduce the number of intraoperative complications associated with cardiopulmonary bypass and ultrafiltration. 2 tab., 1 ill.

The invention relates to medicine, namely to cardiovascular surgery, in particular to methods for providing operations in conditions of cardiopulmonary bypass in children. In pediatric cardiac surgery, after cardiopulmonary bypass, there is an accumulation of fluid in the extravasal space. This leads to pronounced tissue edema and postoperative complications associated with dysfunctions of various organs. The use of diuretics, cardiotonic drugs, changing the cardiopulmonary bypass scheme does not give the desired effect. Blood ultrafiltration (UF) is a method of treating edema in cardiac surgery patients. The classical method of ultrafiltration of blood under conditions of cardiopulmonary bypass is known. It consists in passing the volume of circulating blood through an ultrafilter in order to remove excess fluid from the body. In this case, UV is performed simultaneously with cardiopulmonary bypass (EC). The inlet line of the ultrafilter is installed in the arterial circuit of the EC apparatus, and the outlet line - in the venous reservoir. The pressure in the filter, for ultrafiltration, is created by a pump. Unfortunately, classical ultrafiltration proved to be inapplicable in pediatric cardiac surgery due to hypovolemia. In pediatric cardiac surgery, there is also known a method of blood ultrafiltration, which is the closest to the claimed technical essence and the achieved result. Proposed in 1991 by Nike and Elliott. The authors called it modified. This method was chosen as a prototype. Unlike the classical one, in this ultrafiltration scheme, the location of the ultrafilter was changed. The inlet line of the ultrafilter was installed in the aortic cannula, and the outlet line - in the right atrium. In addition, ultrafiltration (UF) was performed after the end of cardiopulmonary bypass (EC). Such a scheme made it possible to minimize the length of the filter lines and avoid hypovolemia by changing the UV time. The disadvantage of the proposed ultrafiltration scheme is the complexity of its implementation and the impossibility of ultrafiltration during cardiopulmonary bypass. This increases the risk of complications associated with bleeding and air embolism, and leads to uncontrolled hemodilution, especially in young children. The aim of the invention is to reduce the number of intraoperative complications associated with cardiopulmonary bypass and ultrafiltration. This goal is achieved by the fact that when carrying out a modified ultrafiltration, the inlet line of the ultrafilter is placed in the arterial line of the cardiopulmonary bypass circuit, and the outlet line of the ultrafilter is placed in the cannula of the inferior vena cava. New in the method is the location of the lines of the ultrafilter. The location of the supply line outside the aortic cannula significantly reduces the number of complications associated with the EC technique. The location of the output line in the cannula of the inferior vena cava avoids such traumatic manipulation as the installation of this line with a separate line through the right atrial appendage. This arrangement of lines allows the perfusionist to assemble the ultrafilter circuit, fill it, and perform ultrafiltration independently of the surgeon's actions during and after cardiopulmonary bypass. This allows you to keep the hematocrit constant throughout the operation, regardless of the influence of external factors (cardioplegia, the work of cardiotomy suction, etc.). Carrying out ultrafiltration along the EC significantly reduces the time of its implementation after the end of cardiopulmonary bypass. This significantly reduces the risk of intraoperative complications associated with cardiopulmonary bypass and ultrafiltration. In addition, ultrafiltration according to our scheme allows, if necessary, to resume cardiopulmonary bypass without additional recannulation. The drawing shows a diagram of the proposed method. The supply line 2 of the ultrafilter 1 is connected to the arterial line of the IR circuit in the place between the arterial air trap and the aortic cannula. Output line 3 is installed in the cannula of the inferior vena cava. The pressure in the filter, for ultrafiltration, is created by a special vacuum suction 5 and pump 4. The above circuit is collected, filled with liquid and blood simultaneously with the entire IC system. When UV is not needed, supply line 2 is closed. Pump 4 and vacuum suction 5 do not work. When carrying out UV supply line 2 is open, and the pump 4 and vacuum suction 5 start to work. Using this scheme, ultrafiltration is carried out in two modes: 1) simultaneously with cardiopulmonary bypass and 2) after the end of cardiopulmonary bypass. Example 1. Patient M., 2 years old, diagnosis: congenital heart disease, ventricular septal defect. During the defect plasty operation, the time of cardiopulmonary bypass was 1 hour. Modified ultrafiltration was carried out according to the method described in the prototype, ie. the supply line was installed in the aortic cannula, and the output line was installed in a separate line in the right atrial appendage. Below is table 1, which shows the value of hematocrit at various stages of the operation. The ultrafiltration time after IR was 17 minutes. Table 1 shows how the hematocrit falls during the stages of the operation. Such a decrease in it leads to violations of the processes of gas exchange between tissues and blood, acid-base balance, forcing the use of body cooling. In addition, we pay attention to the significant time of ultrafiltration after the end of IR. Example 2. Patient E., 3 years old. Diagnosis: ventricular septal defect. During the defect plasty operation, the time of cardiopulmonary bypass was 1 hour. Modified ultrafiltration was carried out according to the proposed method, i.e., the supply line was installed in the arterial line of the EC system, and the output line was installed in the cannula of the inferior vena cava. Below is table 2, which shows the value of hematocrit at various stages of the operation. The ultrafiltration time after IR was 6 minutes. The presented table shows that the hematocrit value at the stages of the operation, due to the timely conduct of UV during EC, is stable. We draw attention to a significant reduction in the time of UV after IR. Thus, the use of UV according to the new scheme makes it safer, allows you to control intraoperative hematocrit, and significantly reduces the time of ultrafiltration after CPB. References 1. Elliott M.J. Perfusion for pediatric open heart surgery// Seminars In Thoracic and Cardiovascular Surgery.- 1990.- N2.- P. 332-340. 2. Bodt J., Kling D., Bormann B.V. et al. Extravascularlung water and haemofiltration during complicated cardiac surgery// Thoracic and Cardiovascular Surgeon.- 1978.- N 35.- P. 161-165. 3. Naik S.K., Knight A., Elliott M.J. A successful modification of ultrafiltration for cardiopalmonary bypass in children// Perfusion.- 1991,- N 6.- P. 41-50.

Claim

A method for modified blood ultrafiltration under cardiopulmonary bypass conditions by passing the volume of circulating blood through an ultrafilter, characterized in that the ultrafiltrate supply line is placed in the arterial line of the cardiopulmonary bypass circuit, and the output line is placed in the cannula of the inferior vena cava.

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