Učinak primjene kortikosteroida na upalni odgovor i rani poslijeoperacijski tijek nakon operacijskog zahvata totalne korekcije prirođene srčane greške uz primjenu izvantjelesnog krvotoka

doctoral thesis

• Author: Višnja Ivančan; MBZ: 236535
• Mentor: Višnja Majerić-Kogler (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2008-07-03, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Primjena izvantjelesnog krvotoka i podhlađivanje bolesnika tijekom kardiokirurških operacija danas je uobičajeni postupak. Već nekoliko godina poznata je činjenica da primjena izvantjelesnog krvotoka uzrokuje sistemni upalni odgovor organizma u odraslih, a najnovije spoznaje ukazuju da je on jači i s ozbiljnijim posljedicama u djece i novorođenčadi. Dokazi za to su otpuštanje citokina i ostalih pokazatelja akutnog upalnog odgovora u cirkulaciju, koji mogu dovesti do sindroma niskog minutnog volumena srca, višeorganskog zatajenja i smrtnog ishoda nakon operacijskog zahvata korekcije prirođene srčane greške. Sindrom niskog minutnog volumena srca i/ili sistemski upalni odgovor ne rijetka je komplikacija ranog poslijeoperacijskog tijeka. Zbog sve većih spoznaja o komplikacijama vezanim uz primjenu izvantjelesnog krvotoka danas su u primjeni metode koje smanjuju pojavnost sistemskog upalnog odgovora. Jedna od njih je i primjena kortikosteroida u perioperacijskom vremenu. Dokazano je da jednokratna doza kortikosteroida pa makar bila i izuzetno visoka ne može izazvati bilo kakav štetan učinak na organizam. Iako još uvijek nije dokazano koju dozu treba primijeniti i u koje vrijeme prednost prema najnovijoj literaturi a i ovim istraživanjem imaju visoke doze davane kroz 2-3 dana perioperativno. Ovom studijom ispitivan je učinak primjene kortikosteroida u različitim dozama kao i različitim vremenima. Laboratorijski i klinički najbolji ishod postignut je u skupini gdje su davane visoke doze kortikosteroida. Da bi se došlo do pravih spoznaja u daljnjim istraživanjima potrebno je provesti multicentričnu, randomiziranu, dvostruko slijepu, placebo – kontroliranu studiju kako bi se razriješile još uvijek postojeće dileme oko doze i vremena davanja kortikosteroidne terapije.

Abstract (english)

Using of the extracorporeal circulation and cooling the patients during cardiac surgery, today is a usual procedure. For a few years now it is a well known fact that extracorporeal circulation causes a systemic inflammatory response syndrome in adults which is more serious and with deleterious consequences in childrens and infants. The evidence for that is realising of cytocines and others mediators of acute inflammatory response in circulation, which may lead to low cardiac output syndrome, multiorgan failure and letal outcome after surgical total correction of congenital heart disease. Low cardiac output syndrome is well known complication during early postoperative course. Because of a lot of new comprehensions about complications related to extracorporeal circulation, many cardiac centers are using methods which are reducing the appearance of systemic inflammatory response. The one of that method is the use of corticosteroids in perioperative period. It is prooved that single dose of corticosteroids, no matter if it is very high, can not cause any harmfull effect on organism. It is written in literature that despite of no knowledge which dose and in what time to give corticosteroids, and with this study it is prooved that high doses given through 2-3 days perioeratively have the preference. In this study we examine the effects of corticosteroids in different doses and different time. With laboratory data and clinical signs the best outcome was reched in group were was given high doses of corticosteroids. To go through to the real knowledge in further examination it is necessary to conduct through multicentric, randomized, double blind, placebo-controlled study which would help to solve out still existing dilemmas about the dose and the time of giving corticosteroids therapy.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:366652
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 77 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:47:27