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Коллоидные вещества
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Коллоидные вещества

Warning: file_put_contents(): Only 0 of 1482 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 115 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 128 bytes written, possibly out of free disk space in /var/www/filosof/data/www/medservices.info/wp-content/plugins/wp-optimize-by-xtraffic/Application/Service/PepVN_Cache.php on line 684 Warning: file_put_contents(): Only 0 of 110 bytes written, possibly out of free disk 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by admin25.04.2015
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Коллоидные вещества благодаря относительно большой молекулярной массе и способности повышать осмотическое давление плазмы удерживают жидкость в сосудистом русле, способствуют поступлению в кровоток тканевой жидкости, быстро восстанавливают объем циркулирующей крови. Из них широкое распространение при лечении ожогового шока получили декстраны. Полиглюкин имеет относительно высокую молекулярную массу, осмотическое давление его в 3 раза превышает осмотическое давление белков плазмы крови, он хорошо удерживает жидкость в кровяном русле, высокоэффективен для нормализации гемодинамики, борьбы с плазмо-потерей и нарушением диуреза. В течение суток выделяется половина введенного полиглюкина. Однако препараты с высокой молекулярной массой типа полиглюкина наряду с большими достоинствами оказывают неблагоприятное влияние на микроциркуляцию, вызывая стаз крови в капиллярах, и ухудшают ее реологические свойства.

По этой причине в основном американские авторы считают, что введение коллоидов показано лишь после первых 24 ч после ожога, аргументируя это положение следующими соображениями: 1) в первые 24 ч из-за повышенной проницаемости сосудов все инфузионные средства быстро покидают сосудистое русло, и введение коллоидов в этот период может способствовать увеличению отека и отрицательно сказаться на онкотическом давлении. Через 24 ч после ожога проницаемость сосудистой стенки снижается, и в этот период коллоиды (по сравнению с электролитными растворами) более эффективны в восстановлении ОЦК и повышении сердечного выброса; 2) коллоиды, подобные декстрану 70, увеличивают вязкость мочи и тем снижают ее выделение.

Кроме того, они способствуют освобождению гистамина и вызывают блокаду ретикулоэндотелиальной системы. Однако многие европейские авторы придерживаются мнения о целесообразности введения уже в ранний (регидратационный) период наряду с электролитами также и большого количества коллоидных растворов. По данным этих авторов, введение коллоидов благоприятно влияет на ОЦК, коллоидно-осмотическое давление, на функцию сердца и почек, увеличения отеков ими не выявлено. Так, J. Davies вводит коллоиды уже в течение первого часа после поступления больного в количестве 60-90 мл на 10% площади ожога. Если поступление обожженного в больницу задерживается на 2-3 ч, то количество вводимых коллоидов удваивается и утраивается, причем половина этого объема вводится в первые 8 ч после ожога. Дети получали особенно большие объемы коллоидов. Назначение коллоидов продолжается до нормализации или суб-нормализации венозного гематокрита. Скорость введения коллоида регулируют по количеству выделяемой мочи, снижая ее при необходимости до 0,5-1 мл/ч на килограмм массы тела.

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