Общая реаниматология (Dec 2006)
Perioperative Changes in the Pituitary-Adrenal and Pituitary-Thyroid Systems and Their Correction in Females with Severe Gestosis
Abstract
Objective: to study the venous blood levels of adrenocorticotropic hormone (ACTH), cortisol, thyrotropic hormone, and thyroxin in females with severe gestosis in the perioperative period and to develop a method for correction of the hormonal status.Materials and methods. Eighty and nine females in whom delivery had been performed under spinal anesthesia were divided into groups: a control group that comprised females with uncomplicated pregnancy; Group 1 included 26 females with severe gestosis to whom the conventional intensive care was delivered; Group 2 consisted of females with severe gestosis who received in the complex with intensive care the developed hormonal status correction scheme: dexamethasone, 8 mg, was intravenously injected during the development of spinal block; after its development, dalargin, 50 µg/kg/hr was used before the end of surgery; dexamethasone was intravenously given in a dose of 4 mg twice daily during 3 postoperative days. The levels of the hormones were determined by enzyme immunoassay over time: Stage 1 — before surgery; Stage 2 — during surgery; Stages 3, 4, and 5 — on postoperative days 1, 3, and 5, respectively.Results: In physiological pregnancy, a response of the hormonal adaptive system to surgical delivery develops in a certain order: the increased activity of the pituitary-adrenal system with the maximum levels of ACTH and cortisol during surgical delivery gives way to the activation of the pituitary-thyroid system with the achieved maximum level of thyroxin on postoperative day 5. Progression of gestosis to its severe degree is accompanied by a relative reduction in the functional capacities of the pituitary-adrenal system and thyroid. Surgical delivery under spinal anesthesia is attended by the activation of the pituitary-adrenal system, followed by the development of depletion. At this background, postoperative early compensatory activation of the pituitary-thyroid system promotes a relative insufficiency of thyroid functional reserves. At the same time, hormonal provision of postoperative restorative processes is impaired. The stress-limiting effect of the neuropeptide dalargin leads to the rationally inhibited hormonal secretion of the pituitary-adrenal system during surgical intervention in females with severe gestosis and, in combination with replacement therapy with dexamethasone, preserves hormonal reserves in the postoperative period. Correction of relative hypocortisolemia prevents the development of early activation of the pituitary-thyroid system and the depletion of thyroid functional reserves, and normalizes the sequence of activation of endocrine glands.
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