| Abstract | Postreanimacijska faza nastaje nakon uspješne kardiopulmonalne reanimacije koja se manifestira povratom spontane cirkulacije (ROSC). Postreanimacijski sindrom prvi put je spomenut 1960. godine na Institutu za opću reanimatologiju Sovjetske akademije za Medicinske znanosti u Moskvi. Vladimir A. Negovsky, otac reanimatologije, opisuje razliĉita patološka stanja koja se razvijaju nakon uspješne kardiopulmonarne reanimacije (CPR). Najĉešći uzroci iznenadnog srĉanog zastoja (SCA) su: bolesti koronarnih arterija, srĉani udar, kardiomiopatije, bolesti srĉanih zalistaka, kongenitalne srĉane deformacije i problemi u provoĊenju ţivĉanih impulsa. Riziĉni faktori koji pridonose razvoju koronarnih bolesti su: pušenje, konzumacija alkohola i droga, hipertenzija, dijabetes, pretilost, starost, muški spol i dr. Postreanimacijski sindrom (PRS) je jedna vrsta sindroma sustavnog upalnog odgovora (SIRS). Etiopatogenestki put SIRS-a u PRS-u je vezan uz Pathogen Associated Molecular Pattern (PAMP), molekule koje se veţu na receptore za prepoznavanje uzoraka (PRR). U ovom obliku SIRS-a dolazi do upalnog odgovora, koagulopatije, disfunkcije miokarda i nadbubreţne ţlijezde te ishemijsko-reperfuzijske ozljede (IRI). U IRI-ju dolazi do oštećenja tkiva uzrokovanom hipoksijom. Stanice prelaze na anaerobno staniĉno disanje u kojem se proizvodi manje ATP-a te dolazi do disbalanska ionskog gradijenta na staniĉnim membranama. Nastaje endotoksemija uzrokovana citokinskim molekulama, eikozanoidima i aktivacijom komplemenata. Kliniĉki se takvi pacijenti prezentiraju hemodinamski nestabilnima te im je potrebna velika nadoknada volumena. TakoĊer moţe ze razviti povišena temperatura koja se tretira terapijskom hipotermijom. Ostale mjere lijeĉenja su support-ne. |
| Abstract (english) | The postresuscitation phase occurs after successful cardiopulmonary resuscitation (CPR), which is manifested by the return of spontaneous circulation (ROSC). Postresuscitation syndrome (PRS) was first mentioned in 1960 at the Institute of General Reanimation of the Soviet Academy of Medical Sciences in Moscow. Vladimir A. Negovsky, the father of resuscitation, describes the various pathological conditions that develop after successful CPR. The most common causes of sudden cardiac arrest (SCA) are: coronary artery disease, heart attack, cardiomyopathies, heart valve disease, congenital heart deformities and problems in conduction of nerve impulses. Risk factors that contribute to the development of coronary diseases are: smoking, alcohol, drug consumption, hypertension, diabetes, obesity, old age, male gender, etc. PRS is a type of systemic inflammatory response syndrome (SIRS). The etiopathogenetic pathway of SIRS in PRS is related to Pathogen Associated Molecular Pattern (PAMP), molecules that bind to pattern recognition receptors (PRR). In this form of SIRS, there is an inflammatory response, coagulopathy, myocardial and adrenal dysfunction, and ischemia-reperfusion injury (IRI). In IRI, tissue damage is caused by hypoxia. Cells switch to anaerobic cellular respiration, in which less ATP is produced and an imbalance of the ionic gradient on the cell membranes occurs. Endotoxemia occurs caused by cytokine molecules, eicosanoids and complement activation. Clinically, such patients present as hemodynamically unstable and require a large volume replacement. An elevated temperature can also develop, which is treated with therapeutic hypothermia. Other treatment measures are supportive. |
