| Abstract | Stres u medicini je zapravo poremećaj homeostaze. Tijekom operacije organizam je izložen velikom stresu, zbog toga se aktiviraju fiziološki mehanizmi kako bi se tijelo prilagodilo, održalo homeostazu i kako bi oporavak bio što brži i uspješniji. Endokrini odgovor aktivira se u osjetnim živčanim završecima koji šalju podražaje s mjesta kirurške ozljede prema CNS-u, točnije, u paraventrikularne jezgre hipotalamusa, talamus i u postcentralnu vijugu parijetalnog režnja. Vrlo bitne sastavnice odgovora na stres su hormonske i neurohumoralne promjene, a one uključuju aktivaciju hipotalamus-hipofiza-adrenalne (HPA) osovine, simpatikus-adrenergičkog sustava, aktivaciju renin-angiotenzin-aldosteron sustava (RAAS), otpuštanje antidiuretskog hormona (ADH) iz stražnjeg režnja hipofize, izlučivanje ACTH i hormona rasta iz adenohipofize. Bitnu ulogu u regulaciji imunološkog sustava imaju i citokini, medijatori koje luče imunološke stanice, oni se sintetiziraju kao odgovor na upalne procese u tijelu. Zajedničkim djelovanjem živčanog sustava i endokrinih žlijezda ostvaruju se neurohumoralne promjene. Primjer za to je aktivacija simpatoadrenalnog sustava koji uzrokuje otpuštanje katekolamina, noradrenalina i adrenalina. Katekolamini imaju ulogu održavanja hemodinamske stabilnosti i osiguravanje dovoljno izvora energije tijekom stresa.
Na intezitet kirurškog stresnog odgovora može se utjecati korištenjem kirurških metoda koje manje oštećuju tkivo i stvaraju manje ožiljke, isto tako, primjenom adekvatnih anestezioloških protokola, budući da je dokazano da je stresni odgovor manjeg inteziteta ako anestezija blokira neke od prije navedenih hormonskih i neurohumoralnih sustava. |
| Abstract (english) | Stress in medicine is actually a disturbance of homeostasis. During surgery, the body is exposed to significant stress, which is why physiological mechanisms are activated in order for the body to adapt, maintain homeostasis, and to make recovery as quick and successful as possible. The endocrine response is activated in sensory nerve endings, which send stimuli from the site of surgical injury to the CNS, more specifically, to the paraventricular nuclei of the hypothalamus, the thalamus and the postcentral gyrus of the parietal lobe. Very important components of the stress response are hormonal and neurohumoral changes, which include the activation of the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic-adrenergic system, the activation of the renin-angiotensin-aldosterone system (RAAS), the release of antidiuretic hormone (ADH) from the posterior lobe of the pituitary gland, and the release of ACTH and growth hormone from the adenohypophysis. An essential role in the regulation of the immune system is played by cytokines, mediators secreted by immune cells, they are synthesized in response to inflammatory processes in the body. The joint action of the nervous system and endocrine glands results in neurohumoral changes. An example of this is the activation of the sympathoadrenal system, which causes the release of catecholamine, noradrenaline and adrenaline. Catecholamines have the role of maintaining hemodynamic stability and providing a sufficient source of energy during stress.
The intensity of the surgical stress response can be influenced by using surgical methods that damage less tissue and create smaller scars, as well as by applying adequate anesthesia protocols, since it has been proven that the stress response is less intense if anesthesia blocks some of the aforementioned hormonal and neurohumoral systems. |
