Polyglucinum

General characteristics. Structure:

Active ingredient: 60 g of a dextran with a molecular weight from 50000 to 70000.

Excipients: sodium chloride, water for injections.

The solution blood substitute rendering plasma substituting, the antishock, filling volume of the circulating blood and antiagregantny action.

Pharmacological properties:

Pharmacodynamics. A blood substitute, hyperosmotic solution with osmolarity 0,34-0,37¼¼«½ý/kg. Renders the plasma substituting, antishock, filling volume of the circulating blood and antiagregantny action. Owing to the high osmotic pressure exceeding the oncotic pressure of proteins of plasma by 2.5 times causes active attraction of an intercellular lymph (20-25 ml for the I of polymer) and holds it in a vascular bed rather long period, in communication with what the volume of the circulating blood at intravenous administration of drug quickly is recovered. Eliminates disturbances of a system hemodynamics, increases arterial pressure.

Increases suspension stability of blood, possesses the expressed abhesive and antiagregantny action on thrombocytes, promotes elimination of peripheral staz and aggregation of erythrocytes, improves microcirculation, can reduce risk of development of a syndrome of the disseminated intravascular blood coagulation. It is non-toxical, апирогенен

Pharmacokinetics. It is brought out of an organism, preferential by kidneys; during the first 24 h about 50% eliminirutsya, and in 3 days in blood only its traces are defined. A small part of a dextran collects in reticuloendothelial system where gradually is exposed to metabolism to a dextrose. From a circulatory bed completely is removed for 5-7 days

Indications to use:

- hypovolemic shock (the expressed posthemorrhagic hypovolemia, blood losses at childbirth, as a result of an extrauterine pregnancy, etc.);

- traumatic shock (operational shock);

- burn shock;

- prelum syndrome;

- septic shock, shock as a result of intoxication;

- microcirculation disturbance (capillary blood-groove), rheological properties of blood;

- before - and postoperative prevention of an embolism;

- prevention of thrombophlebitises;

- for filling of cardiopulmonary bypasses (in certain proportions with blood).

Route of administration and doses:

Intravenously struyno or kapelno, at acute blood losses vnutriarterialno (in the conditions of a hospital).

The volume and rate of administering is defined by a condition of the patient, size of arterial pressure, heart rate, a hematocrit indicator. Transfusion is carried out in the usual way with observance of rules of production of a transfusion: before transfusion carry out a bioassey (after introduction 5-10 cap 3 min. do a break, then pour 10-15 more cap and after the same break in the absence of reaction symptoms (increase of pulse, a lowering of arterial pressure, a dermahemia, breath difficulty) continue transfusion.

At the developed shock or acute blood loss - intravenously struyno, 0,4-2 l (5-25 ml/kg). After increase in arterial pressure to 80-90 mm hg usually pass to drop introduction with a speed of 3-3,5 ml/min. (60-80 caps/min.).

The intra arterial way of introduction is possible (in the same dosages). Infusions of drug have to be performed under constant control of the main indicators of a system hemodynamics. At substantial increase of the central venous pressure reduce a dose and rate of administering or completely stop.

At blood loss more than 500-750 ml and the expressed anemization of the patient combine administration of drug with hemotransfusion, a packed red cells or a suspension of the erythrocytes necessary for elimination of a fabric hypoxia, and also the freshly frozen plasma containing factors of system of a hemostasis.

For prevention of operational blood loss, and also for the purpose of achievement of artificial hemodilution, prevention of a thrombogenesis and decrease in a tendency to development or progressing of a syndrome of the disseminated intravascular blood coagulation the drug is administered in doses of 5-10 ml/kg (to children - 10-15 ml/kg) in 30-60 min. prior to operational intervention (in case of a considerable lowering of arterial pressure pass to "jet introduction, at a lowering of arterial pressure it is lower than 60 mm hg - intra arterial introduction).

The volume of infusions during surgical influence is defined by the size of operational blood loss (the hematocrit should not decrease lower than 0,3). In the postoperative period jet and drop introduction is efficiently prevention of shock. At burn shock: into the first 24 h enter 2-3 l, into the following of 24 h - 1,5 l. To children in the first 24 h-40-50 ml/kg, in the next days - 30 ml/kg.

At extensive and deep burns combine with administration of plasma, albumine, gamma-globulin; at burns more than 30-40% of a body surface - with hemotransfusion. For prevention of possible dehydration of fabrics it is recommended to combine infusion of drug with administration of crystalloidal solutions in a share ratio 1:2

Features of use:

Drug maintains freezing and can be transported at a temperature to -10ºC. Freezing of drug is not a contraindication to its use on condition of preservation of tightness of packaging.

Recovery of deficit of liquid before introduction of dextrans is required previously from patients with the expressed dehydration. Speed of their introduction should not exceed 500 ml/h. Introduction of the recommended doses practically does not influence system of a hemostasis. Exceeding of the recommended dose can extend a bleeding time.

Against the background of the hemodilution caused by dextrans reduction of concentration of protein and hemoglobin in plasma is possible. The entered quantity of dextrans has to be calculated so that not to reduce hemoglobin lower than 90 g/l (a hematocrit of 27%) by more or less long time. Introduction of dextrans does not interfere with blood typing and carrying out cross matching by standard methods (it is recommended to wash erythrocytes of 0,9% chloride sodium solution prior to a research).

Presence of a dextran at blood can influence results of the fermental methods based on papain.

At a research of content of glucose in blood with use of solutions of sulfuric and acetic acids it is possible to receive concentration of glucose more, than is actually (the last can hydrolyze a dextran).

The dextran reduces transparency of blood, and its presence at blood can change results of measurement of concentration of bilirubin and protein.

It is recommended to take blood samples for establishment of concentration of bilirubin and protein before introduction of dextrans.

At bystry introduction of dextrans large volumes it is possible to provoke development of an acute left ventricular failure and fluid lungs.

In case of complaints to feeling of constraint in breasts, the complicated breath, back pains, and also at approach of a fever, cyanosis, disturbance of blood circulation and breath the transfusion needs to be stopped, in/in to enter 10 ml of 10% of solution of Calcii chloridum, 20 ml of 40% of solution of a dextrose, antihistaminic HP, glucocorticosteroid means and to carry out the corresponding symptomatic therapy.

Use at pregnancy and during breastfeeding – is not present data.

Side effects:

Allergic reactions (hyperemia and itch of skin, Quincke's disease).

Interaction with other medicines:

Polyglucinum cannot be used as solvent for other drugs (adverse physical and chemical interactions are possible).

Use together with other traditional transfusion means is allowed.

Contraindications:

Hypersensitivity to dextran drugs, cardiovascular insufficiency, the proceeding internal bleeding (a liver, lungs, kidneys), a craniocereberal injury, intracranial hypertensia, a hemorrhagic stroke, an anury, a heavy chronic renal failure, thrombocytopenia, clinical situations at which introduction of large volumes of liquids is undesirable (including arterial hypertension, a hypervolemia against the background of a hematocrit indicator lower than 0,3).

With care: the expressed dehydration.

Overdose:

Perhaps excessive increase in the ABP for which normalization enter peripheral vazodilyator.

Storage conditions:

In the dry place at a temperature from -10 °C to +20 °C. To store in the place, unavailable to children. Period of validity of 5 years. Not to use after the expiry date specified on packaging.

Issue conditions:

According to the recipe

Packaging:

Solution for infusions of 6% in bottles glass for blood on 200 or 400 ml with a capacity of 250 or 450 ml corked by rubber bungs and which are pressed out by aluminum caps. For sale through pharmacy chain each bottle with the application instruction is placed in a pack from a cardboard. In case of supply of drug to hospitals on 28 bottles a dose of 200 ml or 15 bottles a dose of 400 ml, bottles stack in boxes (without preliminary laying in packs) with application instructions