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Фармакологическая оптимизация и рациональное использование энтеросорбции

Автор: Gonciar Veaceslav
Степень:доктор хабилитат медицинских наук
Специальность: 14.00.25 - Фармакология, клиническая фармакология
Научные консультанты: Victor Ghicavîi
доктор хабилитат, профессор, Государственный университет медицины и фармации им. Николая Тестемицану
Tudor Lupaşcu
доктор хабилитат, профессор, Институт химии АНМ
Ученый совет:


Диссертация была зашищена 8 октября 2008
Утверждена Национальным Советом 22 января 2009


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Ключевые слова

Медикас Е, карбосем, активированный уголь, энтеросорбция, энтеросорбент, полифепан, оксигенобаротерапия, гипербарический кислород, четыреххлористый углерод, атропина сульфат, пентетразол, стрихнина нитрат, радиоактивный йод, острый токсический гепатит, хронический гепатит, процессы перекисного окисления липидов, антиоксидантная активность, антитоксическая активность.


Complex experimental and clinical studies are dedicated to elucidation of adsorbent capacities of new charcoals Medicas E and Carbosem, obtained from fruit seeds husk, nut shells and grape seeds. Experimental researches in vitro showed with certainty the priorities of physico-chemical properties (big adsorption surface, big volume of mezzo- and micropores, presence of functional groups, etc.) responsible for adsorption of endogen substances depending on the molecular mass. New charcoals proved to be more effective than the medicinal charcoal (MC) in sorption of convulsive toxins (atropine, strychnine, pentetrasoli) with decrease of lethality and manifestations of convulsive syndrome. Medicas E charcoal showed an important priority to MC in more stable and long-lasting sorption of radioactive Iodine in different conditions of pH and temperature of the environment.

In using sorbents Medicas E and Carbosem for a short period (2 days) and for a long period (7-14 days) the oscillations of parameters of carbohydrate metabolism (glucose), proteometabolism (total proteins and their fractions, creatinine, urea, uric acid), fat metabolism (total lipids, triglycerides, cholesterol), electrolytes (sodium, potassium, calcium) and enzymes (AST, ALT, alkaline phosphatase) in intact animals were within normal levels, and in some situations due to intensification of intermediate products capture it was stated an improvement of detoxication and synthetic functions of liver, the same as a decreasing of cholesterol and atherogenic lipids level.

Similar data were obtained in studies on volunteers, where it was demonstrated a modulating action of the sorbent Medicas E on central and peripheral hemodynamics, biochemical parameters, hemogram and on the system of coagulation, determined by initial state and depuration of intermediary products of metabolism.

In experimental conditions the efficiency of enterosorption with Medicas E was demonstrated, especially in association with OBT in treatment of acute toxic hepatitis manifested by decrease of the level of aminotransferases, FA, bilirubin and its fractions, indicators of the syndrome of cytolysis and cholestasis. At the same time it was observed a benefic influence on the antioxidant system of the examined charcoal itself and in association with hyperbaric oxygen, estimated by the positive dynamics of ceruloplasmin, transferrin and ceruloplasmin/transferrin index. Respective modifications were more evident after 10 procedures of OBT in association with enterosorbent with mutual intensification of positive effects.

The results obtained on laboratory animals were confirmed in clinical studies. In patients with chronic toxic and viral hepatitis, hepatic cirrhosis with encephalopathy, using in the complex treatment of sorbents Medicas E and Carbosem contributed practically to normalization of the AST, ALT, GGT, FA, bilirubin level, decreasing of POL process (MDA, DC, TC) and restoring the activity of antioxidant system (SOD, catalase, GR). Concomitantly it was observed a positive dynamic of parameters of cell immunity (T-lymphocytes, T-helpers, T-suppressors) and humoral immunity (B-lymphocytes, Ig M, Ig A, Ig E). The observed conformities agree with a quicker benefic evolution of clinical symptoms.

The results of experimental and clinical studies allowed us to come to a conclusion that new charcoals Medicas E and Carbosem have a benefic therapeutic effect in pathological conditions with modulation of healthy patients’ state. These effects result from typical mechanisms of enterosorbents, through adsorption of toxic substances, metabolic and intermediary products; depuration of digestive juices of toxic products and bacterial toxins; amplification of functions of digestive tract and enzymatic activity; diffusion from blood of toxic and intermediary products with improving of detoxication function of liver and kidneys.