Диализ для собак и кошек при ОПН и ХПН

Диализ для собак и кошек при ОПН и ХПН
Great writing has the power to transport us to new worlds, introduce us to fascinating ideas, and change how we see our own lives. This specially selected compilation brings together articles that exemplify this transformative potential. We've prioritized depth, originality, and readability in choosing these pieces across various genres and topics. Discover your next favorite read among the following standout articles we're excited to share.
  1. https://www.internetwill.co.uk/the-intriguing-world-of-china-replica-rolex-swiss-watches/
  2. https://www.caspar-mode.de/de-beste-screenprotectors-voor-de-huawei-mate-10-lite/
  3. https://www.newcq.org/2025/03/25/the-allure-of-omega-orange-replica-watches-in-luxurious-leather-straps/
  4. https://www.marketing2win.co.uk/the-allure-and-risks-of-omega-seamaster-watch-replicas/
  5. https://www.info-tschernobyl06.de/de-beste-coque-voor-de-iphone-13-pro-bescherming-en-stijl/
  6. https://www.vuurklip.net/testing-procedures-for-elf-bars-in-the-e-cigarette-industry/
  7. https://www.theworkspg.com/warum-macht-das-dampfen-mich-schwindelig/
  8. https://www.twpofwashington.org/de-beste-bescherming-voor-je-lenovo-tab-m10-plus-een-gids-voor-de-perfecte-case/
  9. https://www.transitioningtohealth.net/die-faszination-der-stundenglass-gravity-bong-und-3d-druck/
  10. https://www.colbooks.org/understanding-the-perfect-clone-watch-scam-a-guide-for-watch-enthusiasts/
  11. https://www.linkinglearningtolife.org/de-beste-telefoonhoesjes-voor-de-xiaomi-mi-10-pro/
  12. https://www.compactpower.co.uk/the-allure-of-cartier-tank-louis-watch-replicas/
  13. https://www.pwccwr.org/the-bong-hits-4-jesus-case-a-deep-dive-into-free-speech-and-cannabis-culture/
  14. https://www.uksurvivalschool.co.uk/understanding-the-iso-6149-2-standard-a-comprehensive-overview/
  15. https://pastatehogrally.com/cartier-diamond-replica-watches-the-perfect-blend-of-style-and-affordability/
  16. https://www.meringueboutique.com/het-perfecte-horlogebandje-stijl-en-functionaliteit/
  17. https://www.erythrozyten-info.de/understanding-standards-australia-and-sai-global-a-comprehensive-overview/
  18. https://www.mrsdirect.co.uk/the-allure-of-replica-vintage-omega-speedmaster-watches/
  19. https://www.magnusthemasseur.co.uk/exploring-delmars-standard-textbook-of-electricity/
  20. https://www.mucke-gegen-rechts.de/the-allure-of-the-omega-apollo-replica-a-timepiece-beyond-compare/
  21. https://www.bangkokapartment.org/the-art-of-animal-bongs-a-unique-twist-on-water-pipes/
  22. https://www.millelacsgolf.com/why-does-hookah-make-you-dizzy/
  23. https://www.bomacsolutions.co.uk/de-perfecte-coque-voor-je-iphone-5c-bescherming-en-stijl/
  24. https://www.griffair.co.uk/understanding-the-ansi-z10-standard-a-comprehensive-overview/
  25. https://www.gruene-radler-berlin.de/de-beste-telefoonhoesjes-voor-de-oppo-reno-serie/
  26. https://www.adlershof-convent.de/die-welt-der-e-zigaretten-ein-blick-auf-den-vape-shop-in-saltcoats/
  27. https://www.davidurquharttravel.co.uk/the-allure-of-hublot-replica-watches-a-guide-to-prices-in-dubai/
  28. https://www.psrn.org/the-truth-about-fake-omega-speedmaster-watches/
  29. https://www.aicvb.org/de-beste-telefoonhoesjes-voor-de-oppo-reno2-z/
  30. https://ponyexpressministorage.com/3503
  31. https://www.skitigneslesbrevieres.co.uk/the-importance-of-the-brc-global-standards-directory-in-modern-supply-chain-management/
  32. https://www.northernairelodge.com/wat-is-het-magsafe-hoesje/
  33. https://www.goldenaquarium.net/the-importance-of-pdf-a-1a-standard-in-document-preservation/
  34. https://www.surreyaccidentrepaircentre.co.uk/understanding-finance-and-farm-management-insights-from-standard-bank/
  35. https://www.mindsetappraisals.com/de-beste-samsung-galaxy-s23-hoesjes-bescherming-en-stijl/
  36. https://www.manorfarmgame.co.uk/the-world-of-11-rolex-replica-clone-3135-watches/
  37. https://www.pricechemical.com/the-synchronized-dance-of-time-exploring-the-intricacies-of-dna-replication-through-the-lens-of-a-watch/
  38. https://www.filmcels.co.uk/hublot-diamond-watch-replica-a-closer-look-at-the-world-of-high-quality-replicas/
  39. https://www.silvasurfercomputers.co.uk/the-rise-of-fake-zenith-watches-in-the-usa/
  40. https://www.daltonssteakhouse.com/allergien-gegen-das-dampfen-ein-blick-auf-die-risiken-von-e-zigaretten/
  41. https://www.rudolf-craemer.de/the-adoption-of-common-core-national-educational-standards-implications-and-challenges/
  42. https://www.feinkost-leuchten.de/the-art-of-enjoying-bong-candles-a-unique-fusion-of-aromatics-and-water-pipes/
  43. https://www.tesanj.org/the-allure-of-panerai-luminor-regatta-replica-watches/
  44. https://www.telsis.co.uk/the-impact-of-fake-omega-seamaster-planet-ocean-in-the-uk/
  45. https://www.mnaventures.org/die-welt-der-wasserpfeifen-ein-blick-auf-glas-bongs/
  46. https://www.formazione-spirituale.org/the-allure-of-replica-watches-exploring-the-cheapest-fake-rolex-on-aliexpress/
  47. https://www.saabsavior.com/the-allure-of-the-omega-spectre-a-detailed-look-at-the-lug-to-lug-replica/
  48. https://www.religionandspiritualityforum.com/the-impact-of-boys-vaping-understanding-the-risks-of-e-cigarettes/
  49. https://www.austinareaechosociety.org/the-ultimate-guide-to-finding-the-best-watch-replica-site/
  50. https://www.cpem-marseille.com/the-controversy-surrounding-lucozade-vape-an-analysis-of-the-risks-and-benefits/
  51. https://www.pagedive.com/the-truth-about-fake-tag-heuer-4000-watches/
  52. https://www.kompetenzzentrum-hannover.de/wie-man-eine-wasserpfeife-zeichnet-eine-schritt-fuer-schritt-anleitung/
  53. https://www.erythrozyten-info.de/the-importance-of-milady-standard-cosmetology-in-modern-beauty-education/
  54. https://www.flamingofanny.com/die-welt-der-e-zigaretten-packwoods-1000mg-vape-im-fokus/
  55. https://www.nopornpledge.com/the-importance-of-o-ring-standard-sizes-in-metric-systems/
  56. https://www.fistralbackpackers.co.uk/the-art-of-smoking-exploring-the-world-of-pill-bongs-and-water-pipes/
  57. https://www.cko-mannheim.de/de-beste-screen-protectors-voor-de-vivo-y76-5g/
  58. https://www.container-finden.de/replica-reloj-hublot-geneve-the-risks-and-consequences-of-counterfeit-watches/
  59. https://www.custommarketingco.com/are-elf-bars-banned-exploring-the-controversy-surrounding-e-cigarettes/
  60. https://www.meringueboutique.com/de-perfecte-horlogebandje-van-aerowatch-stijl-en-functionaliteit/
  61. https://www.telecentros.org/die-faszination-der-wasserpfeife-eine-reise-durch-geschichte-und-kultur/
  62. https://www.adoptabritt.org/exploring-the-legal-age-for-vaping-what-age-can-you-vape/
  63. https://www.morrowind-mod.com/the-art-of-enjoying-cookies-and-bongs-a-unique-smoking-experience/
  64. https://www.jarnacny.com/the-controversy-surrounding-diamon-vapes-in-the-e-cigarette-industry/
  65. https://www.writersconferencenyc.org/how-to-spot-fake-audemars-piguet-watches/
  66. https://www.corvettecafe.org/the-controversy-surrounding-best-replica-rolex-black-gmt-watches/
  67. https://www.koleksi.org/who-makes-the-best-replica-rolex-watches/
  68. https://www.phlylabs.de/the-allure-of-omega-watches-a-closer-look-at-replications/
  69. https://www.medanrentalmobil.com/the-allure-of-rolex-submariner-replica-watches-a-deep-dive-into-affordable-luxury/
  70. https://www.audubonmiamivalley.org/die-faszination-von-wasserpfeifen-amsterdam-vodka-bong-und-ihre-bedeutung-in-der-modernen-kultur/
  71. https://www.asklilach.co.uk/de-beste-telefoonhoesjes-voor-de-samsung-s9/
  72. https://www.fraservineyard.com/de-beste-telefoonhoesjes-voor-de-iphone-6s/
  73. https://www.industrial-ventilation.net/the-importance-of-percussion-in-music-education-a-deep-dive-into-standard-of-excellence-book-2/
  74. https://www.mustanghobbies.com/exploring-the-world-of-hookah-tops-a-comprehensive-guide/
  75. https://www.cafelatino-jazz.com/the-rise-of-hookah-pens-a-trend-in-2014-and-beyond/
  76. https://www.daltonssteakhouse.com/dabwood-thc-vape-eine-neue-ara-des-dampfens/
  77. https://ellis-construction.com/3456
  78. https://www.frenchriverconnection.org/the-allure-of-imitation-luxury-watches/
  79. https://www.themediacube.co.uk/understanding-national-metal-roofing-standards-importance-and-implementation/
  80. https://www.fosterfacts.net/la-montre-raplique-un-equilibre-entre-luxe-et-accessibilite/
  81. https://etownpanel.com/3481
  82. https://www.manthorpeforge.co.uk/the-importance-of-iso-business-continuity-standard-22301/
  83. https://marspc.com/how-to-know-when-your-elf-bar-is-done-a-guide-to-electronic-cigarettes/
  84. https://www.bullsheadwilpshire.co.uk/de-beste-screenprotectors-voor-de-oneplus-nord-n10/
  85. https://www.cassandra2.com/vape-liquid-wholesale-the-ins-and-outs-of-e-cigarette-liquid-distribution/
  86. https://www.o2-usa.org/die-kunst-des-handgemachten-handmade-bongs-und-ihre-bedeutung-in-der-wasserpfeifen-kultur/
  87. https://www.midkentvehicleservices.co.uk/the-importance-of-standard-bank-proof-of-payment-pdf-in-financial-transactions/
  88. https://www.auvets.com/the-giraffe-bong-a-unique-addition-to-the-world-of-water-pipes/
  89. https://www.bunburycompany.org/the-allure-of-omega-replicas-a-deep-dive-into-timepieces/
  90. https://www.cewdc.org/where-can-i-buy-a-high-line-replica-rolex-watch-and-not-get-ripped-off/
  91. https://www.trffoodshelf.org/2025/03/26/the-aqua-terra-omega-replica-a-timeless-classic/
  92. https://www.lola-national.org/2025/03/27/de-voordelen-van-een-magnetisch-iphone-7-telefoonhoesje/
  93. https://www.heelspurs.co.uk/les-montres-rolex-lart-de-la-raplique-aaa-suisse/
  94. https://www.beautyskinuk.co.uk/die-faszination-der-wasserpfeifen-eine-reise-in-die-welt-des-bambus-bongs/
  95. https://www.fairleelibrary.org/das-vapen-auf-teneriffa-was-sie-wissen-sollten/
  96. https://www.cubelite.co.uk/the-pros-and-cons-of-purchasing-5-elf-bars-for-20/
  97. https://www.dr-g-dumais.com/3504
  98. https://www.kabelanschluss-anmelden.de/the-art-of-enjoying-heir-bongs-a-deep-dive-into-the-world-of-water-pipes/
  99. https://www.med-bettge.de/the-importance-of-icse-board-1st-standard-books-for-early-education/
  100. https://www.desertpridecenter.org/die-kultur-des-wasserpfeifenrauchens-ein-blick-auf-rakhoi-bong-da/
  101. https://www.businesspursuits.co.uk/the-danger-of-elfbar-queimado-a-cautionary-tale-of-vaping/
  102. https://ellis-construction.com/3451
  103. https://www.cathedraleventcenter.com/de-perfecte-oplossing-voor-stijl-oozoo-horlogeband-in-rozegoud/
  104. https://www.foirephoto-bievres.com/de-beste-screenprotectors-voor-de-ipad-6/
  105. https://www.lesleyharrison.net/the-allure-of-cartier-ecrou-replica-watches/
  106. https://songwritingtipsonline.com/de-beste-coque-voor-ipad-6-bescherming-en-stijl/
  107. https://www.foleygroupinfo.com/3498
  108. https://www.rapidproxy.org/the-allure-of-the-panerai-replica-pam000297-a-blend-of-heritage-and-modern-craftsmanship/
  109. https://www.sopressata.org/the-rise-of-rectangle-vapes-a-look-into-the-future-of-e-cigarettes/
  110. https://etownpanel.com/3482
  111. https://www.kayceecleaningservices.co.uk/de-beste-iphone-covers-bescherming-en-stijl-in-een/
  112. https://www.safety4toddlers.com/the-allure-of-hookah-lounges-in-las-vegas/
  113. https://www.externe-festplatte24.de/the-rise-of-bongs-exploring-the-world-of-water-pipes/
  114. https://www.aids2014community.org/the-truth-behind-breitling-b13356-chronographe-certifie-chronometre-unveiling-the-fake-market/
  115. https://www.sarcoidosisresearch.org/the-importance-of-standard-algorithm-multiplication-in-mathematics-education/
  116. https://www.premierfisheries.co.uk/the-top-ten-rolex-replicas-for-sale/
  117. https://www.griffair.co.uk/understanding-vibration-test-standards-a-comprehensive-guide/
  118. https://www.laptopinfo.co.uk/die-welt-der-e-zigaretten-ein-blick-auf-die-cali-company-und-thc-vapes/
  119. https://www.rc-durch.de/de-perfecte-leer-case-voor-je-iphone-x/
  120. https://www.ccufc.co.uk/the-importance-of-standard-lesson-commentary-in-modern-education/
  121. https://www.bomacsolutions.co.uk/de-voordelen-van-een-privacy-screen-protector-voor-de-oneplus-6/
  122. https://19thave76.com/the-rising-trend-of-vape-hookahs-understanding-prices-and-options/
  123. https://www.bullsheadwilpshire.co.uk/de-geschiedenis-van-airpods-wanneer-kwam-de-eerste-versie-uit/
  124. https://www.omlandmarkinternationalschool.org/2025/03/13/the-allure-of-omega-watch-replicas-in-007-bond-movies/
  125. https://www.clickingagent.com/essential-glass-bong-accessories-for-an-enhanced-smoking-experience/
  126. https://www.peacehousefoundation.org/de-perfecte-bescherming-voor-je-honor-10-telefoonhoesjes/
  127. https://www.marlowvw.co.uk/de-beste-screenprotectors-voor-de-lg-k22/
  128. https://www.orlandovineyard.org/die-vielfalt-der-elf-bar-pi9000-geschmacker-ein-leitfaden-zur-elektronischen-zigarette/
  129. https://www.theulsterscots.com/de-rolex-batman-een-iconische-horlogeband-en-zijn-betekenis/
  130. https://www.cookcountyforeclosurehelp.org/the-legalities-of-vaping-exploring-the-controversy-surrounding-marys-lost-vapes/
  131. https://www.bluemoonbottleneck.co.uk/are-disposable-vapes-being-banned-in-the-uk/
  132. https://www.launchhelmetcams.com/exploring-the-world-of-replica-watches-the-case-of-the-1200-swiss-grade-fake-rolex/
  133. https://www.abbyloopers.org/the-art-of-hookah-exploring-tabaco-para-hookah-and-its-cultural-significance/
  134. https://www.kennelcustoms.co.uk/the-importance-of-national-employment-standards-and-minimum-wage-in-todays-economy/
  135. https://www.gslps.org/die-welt-der-e-zigaretten-der-geek-vape-100w-im-fokus/
  136. https://aea-usa.com/de-perfecte-bescherming-voor-je-oppo-find-x3-neo-telefoonhoesjes/
  137. https://www.hotel-colonia.de/the-art-of-enjoying-swiss-cheese-bongs-a-unique-twist-on-water-pipes/
  138. https://www.inmamarti.com/the-importance-of-national-social-studies-standards-2018/
  139. https://www.sao-paulo-brasilien.de/the-allure-of-breitling-imitations-a-closer-look-at-replica-watches/
  140. https://www.bmw-parts-wholesale.com/the-dangers-of-fake-omega-cards-in-the-watch-industry/
  141. https://www.mikvehyisrael.org/understanding-national-probate-court-standards-ensuring-fairness-and-efficiency-in-probate-proceedings/
  142. https://www.kinsella-consulting-engineers.co.uk/the-impact-of-vaping-on-digestive-health-can-vaping-make-you-feel-bloated/
  143. https://www.churchillcuprugby.com/the-importance-of-understanding-modern-standard-arabic-grammar/
  144. https://www.love-poems-quotes.com/de-beste-samsung-galaxy-j3-hoesjes-bescherming-en-stijl/
  145. https://www.nurseatstarbucks.com/clones-chinos-de-rolex-en-mexico-the-rise-of-replica-watches/
  146. https://www.dasd-dms.org/the-impact-and-importance-of-national-common-core-state-standards/
  147. https://www.usdlc.org/replica-tag-heuer-calibre-36-versus-original-a-comprehensive-comparison/
  148. https://www.kennelcustoms.co.uk/understanding-the-sae-j1402-standard-a-comprehensive-overview/
  149. https://www.goldenaquarium.net/understanding-national-standards-in-music-education/
  150. https://www.vtmorganheritagedays.org/de-beste-screenprotectors-voor-de-galaxy-m33-5g/
  151. https://www.desertstar.co.uk/the-allure-of-cartier-replica-watches-in-the-netherlands/
  152. https://www.coserrc.org/de-beste-hoesjes-voor-de-motorola-edge-2022/
  153. https://www.gruene-radler-berlin.de/de-beste-xiaomi-12-accessoires-voor-jouw-smartphone/
  154. https://www.viande-attitude.com/the-ultimate-guide-to-choosing-the-best-vape-starter-kit/
  155. https://www.cyclingteam.org/exploring-the-world-of-wholesale-swiss-replica-watches/
  156. https://www.jimhjelmcouture.com/de-beste-qvc-laptop-deals-van-het-jaar/
  157. https://www.footprintsusa.net/the-controversy-surrounding-elfbar-bg-and-the-future-of-vaping/
  158. https://www.greenwichwoodworks.co.uk/the-comprehensive-guide-to-glass-bong-prices-understanding-the-market/
  159. https://www.jumpforfunparty.com/de-beste-hoesjes-voor-de-google-pixel-8/
  160. https://www.kamala-yoga.de/the-allure-of-perfect-super-knockoff-watches-a-deep-dive-into-the-world-of-replica-timepieces/
  161. https://www.gerhardtzahntechnik.de/the-impact-of-ace-pens-on-the-vape-industry/
  162. https://www.magnusthemasseur.co.uk/understanding-the-iso-450012018-standard-for-occupational-health-and-safety/
  163. https://www.be-granite-marble.co.uk/de-beste-waterdichte-hoesjes-voor-de-iphone-12-mini/
  164. https://www.peachcobblersale.org/understanding-the-bs4504-standard-a-comprehensive-guide/
  165. https://www.life-in-motion.org/the-allure-of-breitling-replica-leather-strap-watches/
  166. https://www.homeschoolingnb.com/the-world-of-movado-knockoffs/
  167. https://www.bjacool.co.uk/the-allure-of-luxury-exploring-the-world-of-replica-rolex-watches-on-amazon/
  168. https://www.grandnewporthotel.com/the-art-of-rewriting-ap-copy-for-watch-brands/
  169. https://www.ighthamcarpets.co.uk/the-cartier-pasha-watch-replica-automatic-a-timeless-classic/
  170. https://www.alonelysky.com/de-tijdloze-schoonheid-van-het-jacob-jensen-horlogebandje-722/
  171. https://www.joeyo.org/the-impact-of-nikotin-i-elfbar-on-the-electronic-cigarette-industry/
  172. https://www.casayoses.com/exploring-the-ethics-of-purchasing-replica-watches/
  173. https://wolfs111.com/die-welt-der-premium-e-zigaretten-qualitat-und-genuss-im-fokus/
  174. https://www.lionvilleymca.org/the-allure-of-luxury-exploring-the-best-rolex-replicas/
  175. https://www.tierrasdelsol.com/the-art-and-science-of-the-sandglas-gravity-bong/
  176. https://www.composttea.org/the-allure-of-replica-breitling-watches-a-comprehensive-guide/
  177. https://www.workshopforwomen.com/3496
  178. https://www.rudolf-craemer.de/the-role-of-the-national-bureau-of-standards-and-technology-in-modern-society/
  179. https://www.wwoofgreece.org/exploring-the-accusoft-pdf-viewer-standard-trial-a-comprehensive-overview/
  180. https://www.musicserve.net/exploring-the-best-hookah-flavors-a-guide-for-enthusiasts/
  181. https://www.funeral-poems.com/die-welt-der-wasserpfeifen-lustige-bongs-und-ihre-vielfalt/
  182. https://www.insurersoffers.com/the-allure-of-ebays-best-rolex-replicas-a-comprehensive-guide/
  183. https://www.bouchercon2011.com/de-beste-hoesjes-voor-xiaomi-buds-3-bescherming-en-stijl/
  184. https://www.jardinesdegerena.com/die-faszination-des-wasserpfeifenrauchens-ein-blick-auf-die-welt-der-shishas/
  185. https://www.ms-traveling.de/de-beste-telefoonhoesjes-voor-de-samsung-a53-5g/
  186. https://www.alonelysky.com/de-beste-horlogebandjes-voor-de-fitbit-charge-2/
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Гемодиализ является экстракорпоральным, или внепочечным, методом детоксикации. В настоящее время диализ для кошек и собак широко распространён.

Цель – выведение токсинов и метаболитов из крови, а также регуляция ионного состава её плазмы.

Гемодиализ с применением аппарата «искусственная почка»

В условиях ХПН и ОПН организм накапливает растворённые в его жидкостной среде токсины и метаболиты, которые в норме покидают его с мочой. Гемодиализ по сути – искусственное выведение вредных веществ из организма, не справляющегося с данной функцией самостоятельно. Состав жидкостной среды (далее – «воды») в процентном соотношении таков:

  • Вода плотных тканей – 40%;
  • Внутриклеточная вода – 33%;
  • Интерстициальная жидкость и лимфа – 12%;
  • Плазма крови – 4,5%;
  • Вода хрящей – 4,5%;
  • Необменная вода костей – 4,5%;
  • Трансцеллюлярная вода – 1,5%.

Для расчёта параметров диализа для собак и кошек важнее всего учитывать, что «активная вода» организма, нуждающаяся в очистке – это 70% массы тела пациента. Объём «воды», требующий очистки в каждом конкретном случае, называют дозой диализа.

Рассмотрим на примере животного с массой тела 5 кг (и, соответственно, объёмом крови 350 мл), показателем креатинина 500 ммоль/л (миллимоль на литр) и мочевины – 50 ммоль/л. С учётом вышеприведённого процента можно сделать вывод, что указанное количество токсичных веществ растворено в 3,5 л «воды». Поэтому, в частности, в случае уремической интоксикации малоэффективен плазмаферез: в процессе организм лишается 30% плазмы, что составляет 1,5% всей «воды», нуждающейся в очистке.

ОЦК, исходя из расчётной дозы диализа в каждом случае, претерпевает от 3 до 15 циклов очистки в аппарате «искусственная почка». Одного-двух циклов недостаточно: мочевина и креатинин выводятся быстро и качественно, а значит, существенно снижается уровень токсинов, но весь ОЦК составляет лишь 4,5% от поражённой интоксикацией «воды» организма. Сообразно градиенту концентрации токсины из неочищенной части «воды» просачиваются в кровь, затем она проходит очередной цикл очистки в аппарате, возвращается к пациенту, и так далее.

Излишняя интенсивность процедуры с целью скорейшей коррекции состояния животного порождает риск возникновения синдрома нарушенного равновесия (дизэквилибризации). Резкое падение уровня интоксикации влечёт за собой понижение осмотического давления, в то время как в тканях тела и, главное, головного мозга таковое не изменяется: клеточные мембраны в тканях препятствуют быстрому перемещению токсинов. Чтобы нивелировать разницу осмотических давлений, вода стремится проникнуть в кору головного мозга, что грозит развитием его отёка. Поэтому наращивать интенсивность следует постепенно, рассчитывая дозу диализа строго индивидуально, сообразно текущему состоянию, и варьируя от сеанса к сеансу.

Техника гемодиализа

Внутри аппарата «искусственная почка» кровь протекает через диализатор по капиллярам из полупроницаемой мембраны, которые омывает встречный поток жидкости-диализата. Посредством пор в капиллярах происходит взаимообмен веществами, молекулярное строение которых позволяет проникать через поры. Среды внутри и снаружи капилляров в результате этого обмена выравниваются по химическому составу, то есть после очистки обратно в организм пациента поступает кровь, соответствующая по характеристикам ионного состава диализатору. В зависимости от изменения кислотно-щелочного баланса в организме животного меняют и настройки аппарата, регулирующие ионный состав диализата.

Практическое применение

В 95% случаев при ХПН или ОПН у собак и кошек их владельцы обращаются к нам гораздо позже, чем это стоило бы сделать. Со слов многих из них складывается впечатление, что ветеринарные врачи зачастую относятся к гемодиализу как к некой крайней мере, пускаемой в ход в случаях, когда никакие иные методы не привели к улучшению. Это мнение ошибочно, поскольку метод – не панацея и не способен «запустить» полностью отказавшие почки. Он – лишь средство продления их функциональной деятельности.

Индикаторами состояния почек при ХПН или ОПН у кошек и собак служат показатели мочевины и креатинина. В процессе осуществления назначенного лечения у животного берут кровь на анализ и спустя сутки делают это повторно. Для получения реальной картины суточной динамики необходимо делать оба анализа в одной и той же лаборатории – таким образом удастся избежать разности в погрешностях измерений, способной исказить картину.

Рост показателей мочевины и креатинина указывает на неэффективность текущего лечения и «умирание» почек. Чтобы выиграть время, необходимое для выявления причин отказа органа и разработки корректирующих мер, крайне важно оперативно предоставить почкам возможность функционирования в отсутствие угнетающего воздействия.

Если назначенное лечение подобрано в соответствии с требованиями состояния животного, то заметное улучшение должно наступить уже через двенадцать часов. Его отсутствие указывает на необходимость смены тактики, а также вероятность, что при назначении лечения был не учтён какой-то из многочисленных факторов, таких как кислотно-щелочной баланс и ионный состав плазмы, наличие и степень анемии, обезвоживания, истощения, инфекции мочевыводящих путей, присутствие сопутствующих заболеваний и т.п.

Большей частью владельцы животных приходят к нам из других клиник с диагнозом «ХПН».
Хроническая почечная недостаточность – не диагноз!

Это патологическое нарушение работы органа, связанное с отмиранием нефронов и ведущее к утрате функциональности. Однако, если функционирующих нефронов остаётся достаточно, животное благодаря оперативному применению соответствующих мер может по-прежнему вести качественную жизнь.

К гибели нефронов приводят самые разные причины – например, наличие повышенного артериального давления, хронического пиелонефрита, гидронефроза, нефросклероза, некоторых аутоиммунных заболеваний, сахарного диабета и т.д. Иначе говоря, истинный диагноз – это причина отмирания нефронов, а ХПН, как комплекс патологических симптомов, является следствием.

Достоинства и недостатки гемодиализа

Системный подход к лечению ХПН у животных мы уже подробно разбирали. Напомним основные плюсы и минусы.

Достоинства:

  • детоксикацию таким способом можно проводить довольно долго;
  • есть возможность хронического применения;
  • эффект наступает достаточно быстро.

Недостатки:

  • для осуществления необходимо обеспечение постоянного доступа к крупным сосудам посредством катетера. Однако вследствие невнимательности и/или недосмотра животные самостоятельно избавляются от катетеров.

Детоксикацию можно производить с помощью и других методов, которые также были взяты нами на вооружение в качестве средств борьбы с разнообразными интоксикациями и неоднократно доказали свою эффективность. Выбор метода всегда индивидуален и опирается на диагноз, поэтому оперативная и точная диагностика чрезвычайно важна. Ни один из способов не является универсальным, все они имеют ряд противопоказаний.

Плазмаферез

В основе данного метода детоксикации лежит отделение клеточных элементов (лейкоцитов, тромбоцитов, эритроцитов) плазмы, в которой и пребывают токсины в растворённом состоянии. Кровь через специальный катетер поступает в фильтр, где и происходит вышеупомянутое разделение. Обратно к пациенту поступают только клеточные элементы. Одновременно производится восполнение ОЦК с помощью физраствора, что позволяет удержать артериальное давление без изменений в процессе процедуры. За время одного сеанса плазмафереза выводится 40% плазмы, а соответственно, 40% растворённых токсинов.

В самых тяжелых случаях прибегают к донорскому биоматериалу, что позволяет выводить большие объёмы плазмы пациента. Гуманной медицине известен случай отравления дозой ботулотоксина, неоднократно превышающей смертельную, в котором мужчине-пациенту четырежды за сутки полностью заместили весь объём плазмы.

При применении плазмазамены в лечении ОПН у собак и кошек наблюдается прилив сил и появление аппетита в среднем на срок от 36 до 96 часов – до тех пор, пока в организме снова не накопятся отравляющие его вещества. Сама процедура не является лечебной, но позволяет выиграть время для борьбы с первопричиной патологического состояния.

Бытует мнение, что плазмаферез нельзя проводить кошкам, однако оно ошибочно. Конечно, в процедуре используется антикоагулянт – цитрат, который переносится ими плохо. Но им предварительно вводится средство-антидот, которое нейтрализует действие цитрата. В нашей практике к кошкам неоднократно применялся плазмаферез.

Достоинства:

  • простота осуществления;
  • доступность для животных, имеющих массу тела от 1,5 кг;
  • во время процедуры животное может свободно менять положение тела.

Недостатки:

  • в отличие от применения в лечении ОПН у кошек и собак – при ХПН эффекта не даёт. Кровь составляет 7% всей массы тела, поэтому при плазмаферезе выведение 30% её плазмы позволяет избавиться лишь от 2% токсинов во всём организме;
  • выводятся не только вредные, но и полезные вещества. Содержание альбумина, белков, клеточных элементов необходимо постоянно отслеживать;
  • из-за потери альбумина число сеансов ограничено.

Перитонеальный диализ

Суть метода – введение в брюшную полость вещества-диализата, в который по градиенту концентрации через клетки брюшины, выступающей в качестве мембраны, просачиваются токсины.

В нашем центре применяются 3 вида растворов-диализатов с разными градиентами концентрации. Подбор диализата строго индивидуален для каждого пациента.

Перитонеальный диализ можно применять на любом этапе терминальной стадии – даже тогда, когда гемодиализ уже невозможен – а его эффективность не ниже. К тому же диффузия через брюшину позволяет снизить уровень среднемолекулярных пептидов.

По эффективности выведения креатинина и мочевины, а также коррекции ph-баланса и электролитов перитонеальный диализ 3 раза в неделю по 9 часов на сеанс сопоставим с аппаратным гемодиализом по 2 часа три раза в неделю.

Единственным противопоказанием является наличие инфекции передней брюшной стенки.

Недостатки:

  • вследствие невнимательности и/или недосмотра животные самостоятельно избавляются от катетеров, необходимых для проведения процедуры;
  • высока вероятность развития перитонита.

Диализ методом форсированной диареи

Интоксикация осуществляется с помощью раствора Янга. Состав: маннитол – 32.8 г/л (грамм/литр), натрия хлорид – 2.4 г/л, калия хлорид – 0.3 г/л, кальция хлорид – 0.11 г/л, натрия гидрокарбонат – 1.7 г/л. Каждые полчаса животному вводят через зонд по 200-500 мл тёплого раствора. Через полчаса после начала процедуры начинается диарея, которая продолжается около 20 минут после прекращения введения раствора. Процедура проводится 2-3 раза в неделю, каждый сеанс снижает уровень мочевины на 40%.

Достоинства:

  • простота. Желудочный зонд можно быстро ввести с помощью зевника, что безболезненно и безвредно, а в домашних условиях зачастую обходятся без зонда;
  • вкус и запах раствора не вызывают отторжения;
  • невысокая цена раствора (в среднем 180 рублей за литр).

Недостатки:

  • теоретическая вероятность инвагинации кишечника (т.е. внедрения одного его участка в другой, что грозит непроходимостью ЖКТ). На практике за 5 лет применения нами метода не выявлено ни одного случая;
  • через некоторое время кишечник «привыкает», и объём выводимой жидкости падает.

Желудочный (кишечный) лаваж

Когда ослабевает выделительная функция почек, слизистая оболочка желудка включается в азотистый обмен, выделяя мочевину и другие продукты распада азота. Таким образом, промывания желудка (лаваж) дают возможность понизить азотемию (повышенное содержание азотистых метаболитов). Сначала в желудок вводят, а затем откачивают двухпроцентный раствор натрия гидрокарбоната (200-1000 мл). Процедура осуществляется дважды в день 3 раза в неделю.

Достоинства:

  • простота в применении.

Недостатки:

  • в силу того, что желудочная среда кислотна, а раствор является щелочным, существует вероятность развития гипоацидного гастрита.

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Наши специалисты

Алипов Александр Андреевич Познакомиться x

Окончил Санкт-Петербургскую Академию Ветеринарной Медицины.

По окончании был приглашен в аспирантуру на кафедру фармакологии.

Тема кандидатской диссертации – «Особенности васкуляризации сосудов головы и шеи млекопитающих».

Алипов Александр Андреевич
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Суворов Олег Николаевич Познакомиться x

Опыт работы с 2005

Специализация нефрология

Образование Санкт-Петербургская Государственная Академия ветеринарной мtдицины, 2005

Дополнительное образование, оконченные курсы, стажировки:

2006-2009 год Аспиратнт кафедры общей и частной хирургии СПБГАВМ.

Суворов Олег Николаевич
suvorov-oleg-nikolaevich

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