Info

++

++

++

contractility contractility

Abbreviations: + increased effect, - decreased effect, +/- variable effect. Effects may be attenuated by anesthetic/analgesic techniques and cardiovascular medications.

nutrients. The wound requires elevated levels of oxygen, glucose, free fatty acids, amino acids, lactic acid, and ketone bodies to satisfy the nutritional needs of neutrophils, macrophages, and fibroblasts. Blood levels of catecholamines (epinephrine, norepinephrine), catabolic hormones (glucagon, cortisol, growth hormone), and cytokines (interleukin-1, tumor necrosis factor) increase in proportion to the degree of tissue injury and the number of white blood cells invading the surgical wound (1-3). Insulin resistance and enhanced hepatic/renal gluconeogenesis are most pronounced immediately after surgery and decrease over several days. The hyperdynamic and catabolic response (proteolysis, lipolysis, and gluconeogenesis) slowly resolve once new capillaries form within the healing wound. A prolonged stress response suggests inadequate nutrient delivery to the wound or infection (3,12,13). Still unanswered is whether hyperglycemia is a mechanism to optimize wound homeostasis or an unwanted side effect of the stress response?

0 0

Post a comment