prikaz prve stranice dokumenta USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA
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doctoral thesis
USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA
Rijeka: University of Rijeka, Faculty of Medicine, 2018. urn:nbn:hr:184:790233
Velčić Brumnjak, Sandra
University of Rijeka
Faculty of Medicine
Department of Anaesthesiology,reanimatology and Intensive Care

Institutional repository: Repository of the University of Rijeka, Faculty of Medicine

Cite this document

Velčić Brumnjak, S. (2018). USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA (Doctoral thesis). Rijeka: University of Rijeka, Faculty of Medicine. Retrieved from https://urn.nsk.hr/urn:nbn:hr:184:790233

Velčić Brumnjak, Sandra. "USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA." Doctoral thesis, University of Rijeka, Faculty of Medicine, 2018. https://urn.nsk.hr/urn:nbn:hr:184:790233

Velčić Brumnjak, Sandra. "USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA." Doctoral thesis, University of Rijeka, Faculty of Medicine, 2018. https://urn.nsk.hr/urn:nbn:hr:184:790233

Velčić Brumnjak, S. (2018). 'USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA', Doctoral thesis, University of Rijeka, Faculty of Medicine, accessed 20 April 2024, https://urn.nsk.hr/urn:nbn:hr:184:790233

Velčić Brumnjak S. USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA [Doctoral thesis]. Rijeka: University of Rijeka, Faculty of Medicine; 2018 [cited 2024 April 20] Available at: https://urn.nsk.hr/urn:nbn:hr:184:790233

S. Velčić Brumnjak, "USPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA", Doctoral thesis, University of Rijeka, Faculty of Medicine, Rijeka, 2018. Available at: https://urn.nsk.hr/urn:nbn:hr:184:790233

Metadata
TitleUSPOREDBA UTJECAJA KONTINUIRANE EPIDURALNE I MULTIMODALNE SUSTAVNE ANALGEZIJE TE PERIFERNIH ŽIVČANIH BLOKOVA NA PROMJENU STANIČNE IMUNOSTI U BOLESNIKA NAKON UGRADNJE POTPUNE ENDOPROTEZE KOLJENA
Title (english)THE IMPACT OF CONTINOUS EPIDURAL AND MULTIMODAL SYSTEMIC ANALGESIA AND PERIPHERAL NERVE BLOCKS ON THE CELLULAR IMMUNITY IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY
AuthorSandra Velčić Brumnjak
MentorVlatka Sotošek Tokmadžić (mentor)
Committee memberAlen Protić (predsjednik povjerenstva)
Committee memberAlemka Markotić (član povjerenstva)
Committee memberGordan Gulan (član povjerenstva)
GranterUniversity of Rijeka
Faculty of Medicine
(Department of Anaesthesiology,reanimatology and Intensive Care)
Rijeka
Defense date and country2018-12-14, Croatia
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Anesthesiology and Reanimatology
Universal decimal classification
(UDC)		61 - Medical sciences
Abstract
Cilj istraživanja: Kirurška tkivna ozljeda nakon ugradnje endoproteze koljena (TKR) uzrokuje snažnu bol i stres koji induciraju snažni proupalni odgovor sa posljedičnom nishodnom regulacijom imunološkog odgovora. Uspostavljanje učinkovite poslijeoperacijske analgezije koja adekvatno obezboljuje i održava imunološku ravnotežu od krucijalne je važnosti. Cilj rada je istražiti utjecaj analgezije: na promjene udjela limfocita i perforinsku ekspresiju u pojedinim limfocitnim subpopulacijama te na upalni i stresni odgovor u bolesnika nakon TKR u ranom poslijeoperacijskom razdoblju. Ispitanici, materijali i metode: Istraživanje je obuhvatilo 90 bolesnika u kojih je bol liječena epiduralnom analgezijom (Grupa 1), ishijadičnim i femoralnim živčanim blokom (Grupa 2) i sustavnom analgezijom (Grupa 3). Bol se bilježila u mirovanju i u pokretu putem VAS ljestvice te su uzorci periferne venske krvi prije (T1), nakon operacije (T2), 24 (T3) i 72 (T4) sata nakon operacije. Detektirali smo udjele limfocita T, stanica NK, stanice NKT i njihovih subpopulacija te je analiziran udio perforina u navedenim stanicama. Koncentracije IL-1β, IL-6 i TNF-α u plazmi te katekolamina i kortizola analizirali smo u istim vremenima. Rezultati: Bolesnici u Grupi 1 i Grupi 2 osjećali su značajno manju bol usporedbom s Grupom 3 te je također uočeno smanjenje učestalosti limfocita T, njihovih subpopulacija, stanica NKT, perforin pozitivnih CD3+CD8+CD56- limfocita u Grupi 3 u usporedbi s Grupom 1 i 2. Uočen je pad koncentracije IL-1β i IL-6 te kortizola i noradrenalina u Grupi 1 i 2 u usporedbi s Grupom 3. Zaključak: Regionalna analgezija učinkovitije održava staničnu imunost, perforinsku ekspresiju u limfocitima te neuroendokrini i upalni odgovor u ranom poslijeoperacijskom razdoblju nakon TKR.
Abstract (english)
Objectives: Pain and surgical stress after total knee replacement (TKR) cause profound pro-inflammatory response followed by down-regulation of immune response. It is mandatory to perform the most effective analgesia in order to maintain immune and stress balance. The aim of this study was to analyze the impact of analgesia on frequency of lymphocytes and perforin expression in peripheral blood lymphocytes as well as on inflammatory and stress response in patients after TKR. Patients and Methods: Ninety patients undergoing TKR were allocated into Groups 1, 2, and 3 and received epidural analgesia, sciatic and femoral nerve blocks, and systemic analgesia, respectively. Postoperative pain was assessed at rest and on movement before surgery, after surgery, after 24 and 72 hours. Blood samples were collected at the same time points. The frequencies of T lymphocytes, NK and NKT cells and their subsets as well as their perforin expression were analyzed. Serum levels of TNF-α, IL-6 and IL- β as well as concentrations of urine catecholamines and serum cortisol were measured and analyzed. Results: Patients in Group 1 and 2 experienced less severe pain than in Group 3. There was a significant decrease in the frequency of T lymphocyte, their subsets and NKT as well as lower levels of perforin and perforin+ CD3+CD8+CD56- lymphocytes were observed in Group 3 than in Groups 1 and 2. We observed lower concentrations of IL-1β and IL-6 as well as concentrations of cortisol and norepinephrine in Groups 1 and 2 than in Group 3 in early postoperative period. Conclusion: Regional analgesia is more effective in maintaining cell mediated immunity and perforin expression in lymphocytes as well as in reducing the neuroendocrine and inflammatory response compared to systemic analesia.
Keywords
Keywords (english)
Languagecroatian
URN:NBNurn:nbn:hr:184:790233
Study programmeTitle: Biomedicine Postgraduate (doctoral) study programme
Study programme type: university
Study level: postgraduate
Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
Type of resourceText
File originBorn digital
Access conditionsAccess restricted to students and staff of home institution
Terms of useLicence In copyright icon
Created on2019-01-18 13:41:13