Uticaj intraoperativne hipotermije na hormonski odgovor na stres kod hirurških bolesnika
Sažetak
Uvod/Cilj. Hirurški stress sam po sebi, kao i u kombinaciji sa hipotermijom izazvanom dejstvom opšte anestezije, pokreće hormonski odgovor na stres koji karakterišu promene u nivoima kateholamina i drugih regulatornih hormona. Cilj rada bio je da se utvrdi akutni hormonski odgovor na stres kod bolesnika podvrgnutih dugotrajnim hirurškim intervencijama, kao i da se ispita efikasnost spoljašnjeg i unutrašnjeg zagrevanja u ublažavanju tih promena. Metode. Istraživanjem je obuhvaćeno ukupno 60 bolesnika podvrgnutih velikim hirurškim intervencijama na otvorenom abdomenu, koji su nasumično podeljeni u 4 grupe: kontrolnu koja nije dodatno zagrevana (C), grupu koja je zagrevana madracem sa toplim vazduhom (W), grupu koja je zagrevana infuzijom aminokiselina (A) i grupu koja je zagrevana kombinacijom te dve metode (A+W). Unutrašnja temperatura merena je ezofagealnom sondom. Ispitivana je koncentracija adrenalina, noradreanlina, kortizola, prolaktina i testosterona. Uzorci krvi uzimani su 90 min pre i 120 min posle završetka hirurške procedure (za kateholamine), a u dodatna dva termina za ostale hormone (24 i 48 sata nakon završetka operacije). Rezultati. U W i A+W grupi temperatura se nije razlikovala tokom perioda praćenja, dok se u C i A grupi konstantno snižavala, sa statistički značajnom razlikom između momenta uvođenja u anesteziju i 120 min
posle operacije (35,61 ± 0,42 vs. 33,86 ± 0,71 °C; p < 0,000, odnosno 35,81 ± 0,54 vs. 34,45 ± 0,41 °C; p < 0,000). Koncentracija kateholamina je u svim grupama značajno porasla tokom operacije, a najviše vrednosti izmerene su u nezagrevanoj grupi (777,07 ± 800,08 vs. 106,13 ± 89,63 pg/mL za adrenalin i 1349,67 ± 984,16 vs. 580,53 ± 465,38 za noradrenalin, p < 0,000). Koncentracije kortizola i prolaktina takođe su porasle u istim intervalima, sa tendencijom normalizacije nakon 48 sati. Naprotiv, koncentracije testosterona značajno su se snižavale posle 120 min i niske vrednosti su se održavale kroz ceo period praćenja (48 sati). Osim u slučaju testosterona, promene svih ostalih hormona ublažene su kod zagrevanih bolesnika u poređenju sa kontrolnom grupom. Zaključak. Posmatranjem obe ispitivane karakteristike hirurškog stresa (hipotermija i hormonski odgovor na stres), utvrđeno je da je u njegovoj prevenciji najefikasnija kombinacija endogenog zagrevanja aminokiselinama i spoljašnjeg zagrevanja madracem sa toplim vazduhom.
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