| Autor: |
MacColl, Harry, Morton, Sarah, Vasireddy, Aswinkumar |
| Zdroj: |
Surgery (0263-9319); Jun2024, Vol. 42 Issue 6, p373-377, 5p |
| Abstrakt: |
Trauma is a term used to encompass a wide range of pathologies. It results in a complex response initially described in 1942 as an acute 'ebb' phase of catabolism followed by anabolism in the 'flow phase'. Others have described the process as a 'nervous' initial phase, closely followed by an 'immune' phase which then develops into a late 'endocrine' phase. Initially there is a shift to anaerobic glycolysis in the resulting hypoxic environment. Hypotension and tachycardia occur alongside increased vessel permeability and vasodilatation. Lipolysis and glycogenolysis have key roles in substrate supply, with insulin resistance and increased gluconeogenesis resulting in ongoing hyperglycaemia but with relatively poor utilization. Proteolysis of skeletal muscle to supply energy substrates can result in limitations in wound healing and rehabilitation. Acutely, acidosis and hypothermia are implicated in trauma-induced coagulopathy, with tissue hypoperfusion an additional risk factor. Hypercoagulability may also be seen, due to impaired anticoagulant activity, particularly in penetrating trauma. Neutrophils and macrophages are attracted to injured sites as part of the immune response, alongside both a cytokine and acute phase protein response. Clinicians should understand these processes and implicate measures to limit the potential adverse effects of the body's metabolic response. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Supplemental Index |
| Externí odkaz: |
|
Full Text from ScienceDirect