Экстракорпоральные методы лечения тяжелых форм геморрагической лихорадки с почечным синдромом

THE AIM of the investigation was to sum up the personal experiences with treatment of patients with moderate and severe forms of hemorrhagic fever with renal syndrome (HFRS). PATIENTS AND METHODS. In the period from 1973 till 2003 under observation there were 355 patients with the medium severity of the disease and sever forms of HFRS. Before 1979 efferent methods of treatment were used in 48% of the patients (50 from 105). Later the optimization of hemodialysis (HD) regimens allowed this method to be used in 128 out of 180 patients (69.5%). Finally, the estimation was made of the results of treatment of 50 patients by HD only, by plasmapheresis (PF) only (n=50) and in 15 patients with polyorganic failure treated by a combination of HD and PF. RESULTS. Lethality in the years from 1973 till 1979 made up 16.1%, from 1980 till 1990 6.1%. The further decrease of lethality (since 1989) was associated with using PF. Eventually, a clear algorithm was developed for treatment of patients with severe forms of HFRS. Immediately after admission the patient underwent massive PF (the volume of plasma exfusion not less than 1000 ml). If the patient failed to reestablish diuresis, HD with anticoagulation with fractionated heparins should be started by the indications with continuing PF. CONCLUSION. Treatment of patients with moderate and severe forms of HFRS should be started with massive PF. If the patient has an oligoanuric stage of acute renal failure and indications for HD, the procedure should be accompanied with anticoagulation with fractionated heparins. Using autocryoplasma in repeated plasmaphereses and in the stage of polyuria considerably lessened the cost of treatment.