Журнал «Медицина неотложных состояний» Том 16, №3, 2020
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The pharmacodynamic aspects of the action of polyhydric alcohols in the practice of intensive care
Авторы: Konovchuk V.M., Kushnir S.V., Andrushchak A.V.
Bukovinian State Medical University, Chernivtsi, Ukraine
Рубрики: Медицина неотложных состояний
Разделы: Медицинские форумы
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Background. The combination of non-insulin-dependent diabetes mellitus with endogenous purulent-septic genesis syndrome is a fairly common nosology. The search of the ways to optimize the results of its treatment, after screening observations, led to the expediency to consider the pharmacodynamic aspects of the action of polyhydric alcohols through the prism of homeostatic support functions. Detailing this direction was focused on considering the action of xylate mediated through the volumo- and osmoregulatory function of the kidneys.
The purpose of the study was to investigate the effect of xylate on the volumo- and osmoregulatory function of the kidneys in insulin-dependent diabetes mellitus complicated by the syndrome of endogenous intoxication of purulent-septic origin.
Material and methods. The study group was consisted of 53 patients with non-insulin-dependent diabetes mellitus complicated by the syndrome of endogenous intoxication of purulent-septic origin (IDDMSEI). The indicators which characterize the state of the volumo- and osmoregulatory function of the kidneys were investigated under the condition of infusion loading (3 ml/kg/h for three hours) with Ringer's solution or xylate within the fragments of planned intensive care.
Results. The loading of Ringer's solution increases the clearance of sodium by 260.0 ± 47.8 % (Δ, p < 0.05), without changes in the concentration of sodium ions in the blood plasma and filtration fraction, and purification of blood plasma from osmotically active substances by 147.0 ± 46.9 % (Δ, p < 0.05). The infusion loading of xylate of patients with IDDMSEI increases sodium clearance by 316.0 ± 57.2 % (Δ, p < 0.05), and clearance of osmotically active substances — by 164.0 ± 52.5 % (Δ, p < 0.05) in comparison to the starting values.
Conclusions. The increase in the extracellular space infusion solutions mode 3 ml/kg/hour for three hours in patients with insulin-independent diabetes complicated syndrome of endogenous intoxication septic genesis activates volumo- osmoregulatory and renal function. At the same time, xylate by 56 % (p < 0.05) outweighs the volumetric activity of the Ringer’s solution and, accordingly, osmoregulatory — by 17 % (p < 0.05). The activation of the renal function of volumetric function is by reducing the reabsorption of sodium and water in the proximal nephron, without increasing the glomerular filtration rate and with the increasing the distal transport of sodium and water.