INSULINSKA REZISTENCIJA I HIRURŠKI STRES

Dušan D Micić; Nebojša M Lalić; Vladimir R Djukić

doi:10.5937/mp67-12700

Dušan D Micić Klinika za urgentnu hirurgiju Urgentni centar Klinički centar Srbije
Nebojša M Lalić Klinika za endokrinologiju, dijabetes i bolesti metabolizma Klinički centar Srbije Medicinski fakultet
Vladimir R Djukić Klinika za urgentnu hirurgiju Urgentni centar Klinički centar Srbije Medicinski fakultet

DOI: https://doi.org/10.5937/mp67-12700

Sažetak

Hirurška intervencija uzrokuje stresnu reakciju u organizmu dovodeći do pojave inflamacije i insulinske rezistencije. Insulinska rezistencija u postoperativnom periodu je zaštitni mehanizam kako bi se organizmu osigurale zalihe ugljenih hidrata koje koriste glukozno-zavisna tkiva kao što je mozak. Operacija i drugi vidovi trauma povećavaju metabolizam, oksidativne procese i kataboličke reakcije kao što su razgradnja glikogena, masti i proteina. Insulinska rezistencija se postoperativno javlja u ekstrahepatičnom tkivu, prevashodno skeletnim mišićima. Stepen insulinske rezistencije i dužina njenog trajanja zavisi od stepena traumatizacije tkiva. Minimalne hirurške intervencije uzrokuju slabiji inflamatorni odgovor i kratkotrajniji pad insulinske senzitivnosti dovodeći do manjeg broja postoperativnih komplikacija kao što su infekcija i kardiološke komplikacije i do kraćeg postoperativnog oporavka. Citokini čiji nivo se povećava u postoperativnom periodu su IL-6 i TNF-alfa, a zabeleženo je i povećanje reaktanta akutne faze, CRP. Preoperativna primena infuzija glukoze sa insulinom smanjuje kataboličke procese uzrokovane stresom i povoljno deluje na insulinsku senzitivnost.

Nezavisno od vrste hirurške operacije koja se primenjuje, stepen postoperativne insulinske rezistencije, odnosno smanjenje insulinske senzitivnosti direktno utiču na dužinu boravka u bolnici i pojavu komplikacija u postoperativnom periodu. Minimalnom invazivnom hirurgijom smanjuje se postoperativni hirurški stres i postoperativna insulinska rezistencija.

Biografije autora

Dušan D Micić, Klinika za urgentnu hirurgiju Urgentni centar Klinički centar Srbije

Klinički asistent

Nebojša M Lalić, Klinika za endokrinologiju, dijabetes i bolesti metabolizma Klinički centar Srbije Medicinski fakultet

Akademik

Vladimir R Djukić, Klinika za urgentnu hirurgiju Urgentni centar Klinički centar Srbije Medicinski fakultet

Profesor

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