Adaptive capabilities after various types of surgical interventions in oncological patients
Background. Correction of the stress response is an important task, since it significantly affects the outcome of surgical treatment, in particular in oncological patients. The neuroendocrine response to surgery is manifested, first of all, by activation of the hypothalamic-pituitary and sympathoadrenal systems. Cortisol plays a more significant role in the body’s response to surgical trauma, and the degree of its increase depends on the severity of the surgical trauma. No less important marker of surgical stress is insulin, the main anabolic hormone that suppresses protein catabolism and lipolysis. In a healthy body, the ratio between insulin and cortisol secretion has a relatively stable equilibrium. Surgical intervention is a stress, the result of which is the dysfunction of all body systems that get a pathological directivity and cause postoperative dysfunction of various organs and systems. Thus, the evaluation and search for ways of perioperative modulation of the surgical stress response are the most urgent tasks of anesthesiology. The purpose of the work was the determination of the level of stress hormones cortisol, insulin and their ratio in oncological patients before and after various surgeries involving multiple organs to evaluate the stress response and adaptive capabilities of the organism. Materials and methods. Surgeries on the abdominal and thoracic cavities involving two or more organs and systems were performed in 25 cancer patients. The study of cortisol and insulin levels was carried out at the following stages: before surgery and seven days after it. The serum level of cortisol and insulin was determined by enzyme immunoassay method. Statistical analysis of the data was performed by means of Statistica, the statistical software package for PC, using parametric (Student’s and Fisher’s tests) and non-parametric methods for small samples. The dynamics of cortisol, insulin content and their ratio was studied to evaluate adaptive possibilities. In the examined oncological patients, the level of hormones (cortisol, insulin) and their ratio in the blood serum before the operation were heterogeneous. Considering that the nature of the body’s endocrine response to stress can vary, the severity of the stress level should be determined not by the absolute values of cortisol or insulin, but by the value of the coefficient, which reflects the ratio of the percentage values of these hormones (stress indicator). The stress indicator suggests that before the surgery, patients had two variants of manifestations of maladaptation disorders: tension of compensatory mechanisms or depletion of adaptive possibilities. Results. Seven days after surgeries involving multiple organs, there is a significant tension in the adaptive possibilities, which indicates the need to limit stress reactions, as well as a significant depletion of the adaptive possibilities of the body and the need to increase the compensatory reserves. Conclusions. The data obtained indicate violations in universal mechanisms of stress tolerance during surgeries involving multiple organs in cancer patients and the need to search for an increase in adaptive possibilities and stress tolerance in them by correcting a stress response, since it significantly affects the success of surgical treatment.
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Ovechkin A.M. Hirurgicheskij stress-otvet, ego patofiziologicheskaja znachimost’ i sposoby moduljacii / A.M. Ovechkin // Regionarnaja anastezija i lechenie ostroj boli. — 2008. — Vol. 2. — S. 49-62.
Kehiet H. Multimodal approach tocontrol postoperative pathophysiology and rehabilitation / Н. Kehiet // British Journal of Anaesthesia. — 1997. — Vol. 78(5). — P. 606-667.
The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care / White P.F., Kehiet H., Neal J.M. et al. // Anasthesia & Analgesia. — 2007. — Vol. 104(6). — Р. 1380-1396.
Measurement of serum free cortisol shows discordant responsivity to stress and dynamic evaluation / Christ-Crain M., Jutla S., Widmer I. et al. // The Journal of Clinical Endocrinology and Metabolism. — 2007. — Vol. 92(5). — P. 1729-1735.
Nicholson G. Peri-operative stroid supplementation / G. Nicholson, G.M. Hall, J.M. Burrin // Anaesthesia. — 1998. — Vol. 53(11). — P. 1091-1094.
Thorell A. Insulin resistance: a marker of surgical stress / A. Thorell, J. Nygren, O. Ljungqvist // Current Opinion in Clinical Nutrition and Metabolism Care. — 1999. — Vol. 2(1). — P. 69-78.
Ljuboshevskij P.A. Vozmozhnosti ocenki i korrekcii hirurgicheskogo stress-otveta pri operacijah vysokoj travmatichnosti / P.A. Ljuboshevskij, A.M. Ovechkin // Regionarnaja anastezija i lechenie ostroj boli. — 2014. — Vol. 8(4). — S. 5-21.
Debouough J. The stress response to trauma and surgery / J. Debouough // British Journal of Anaesthesia. — 2000. — Vol. 85(1). — P. 109-117.
Panin L.E. Biohimicheskie mehanizmy stressa: Monografija. — Novosibirsk, 1983. — 230 s.
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