Koroner Arter Bypass Cerrahisi Öncesindeki Plazma Total Antioksidan Kapasite Düzeylerinin İskemi-Reperfüzyon Hasarı İle İlişkisi

Ali Taşkıran; Hakan Tuna; Sevgi Eskiocak; Ülkü Sarpkaya; Mustafa Çıkırıkçıoğlu; Turan Ege; Enver Duran

Effort Restriction in Cases with Chronic Obstructive Pulmonary Disease

Yıl 2005, Cilt: 2005 Sayı: 1, 16 - 22, 01.01.2005

Ali Taşkıran Hakan Tuna Sevgi Eskiocak Ülkü Sarpkaya Mustafa Çıkırıkçıoğlu Turan Ege Enver Duran

Öz

Patients with chronic obstructive pulmonary disease usually manifest decreases in functional capacity, endurance time at submaximal exercise, and maximal exercise performance compared to age- and sex-matched healthy individuals. The main pathophysiologic changes in this disease are obstruction of expiratory airways and/or pathologic alterations in the lung parenchyma. Many factors are associated with decreased exercise tolerance, including increased airway resistance, inadequate ventilation, increased elastic loading of ventilation, hyperinflation, gas exchange abnormalities, mechanical weakness of respiratory muscles, and varying degrees of disturbances in the central and peripheral nervous systems due to hypoxic response. Skeletal muscles also undergo pathological changes similar to those in ventilation muscles. All these result in decreases in functional capacity and exercise tolerance, giving rise to dyspnea during minimal activity and even at rest. In order to break this vicious circle, supporting rehabilitation programs have to be combined with medical treatment. Turkish Başlık: Kronik Obstrüktif Akciğer Hastalığı Olan Olgularda Efor Kısıtlılığı Anahtar Kelimeler: Solunum egzersizi; egzersiz testi; egzersiz terapisi; egzersiz toleransı/fizyoloji; akciğer hastalığı, obstrüktif/ fizyopatoloji; kas zayıflığı/etyoloji; solunum mekaniği; solunum kasları/patoloji Kronik obstrüktif akciğer hastalığı olan olguların fonksiyonel kapasiteleri, submaksimal egzersizlerdeki dayanıklılık süreleri ve maksimal egzersiz performansları, aynı yaş ve cinsteki kişilerle karşılaştırıldığında genellikle azalmıştır. Bu hastalıkla ilgili temel fizyopatolojik değişiklikler, ekspiratuvar hava akımında obstrüksiyon ve/veya akciğer parenkimindeki patolojik değişikliklerdir. Hava yolu direncinin artması, verimsiz ventilasyon, solunumun elastik yükünün artması, hiperenflasyon, gaz değişim anomalileri ve mekanik olarak solunum kaslarının güçsüzlüğü, merkezi ve periferik sinir sisteminde hipoksik yanıtla ilgili değişik derecelerdeki bozukluklar, egzersize toleransın azalmasına yol açmaktadır. İskelet kaslarında da solunum kaslarına benzer şekilde patolojik değişiklikler gözlenmiştir. Zamanla fonksiyonel kapasite ve egzersiz toleransı azalır, bunlara bağlı olarak hafif düzeyde bir aktivite sırasında, hatta istirahat sırasında dahi dispne gelişir. Bu kısır döngünün kırılması için tıbbi tedavinin yanında mutlaka destekleyici rehabilitasyon programları uygulanmalıdır.

Anahtar Kelimeler

Breathing exercises; exercise test; exercise therapy; exercise tolerance/physiology; lung diseases, obstructive/ physiopathology; muscle weakness/etiology; respiratory mechanics; respiratory muscles/pathology

Kaynakça

Terada LS. Hypoxia-reoxygenation increases O2-. efflux which injures endothelial cells by an extracel- lular mechanism. Am J Physiol 1996;270(3 Pt 2): H945-50.
Cheeseman KH, Slater TF. An introduction to free radical biochemistry. Br Med Bull 1993;49:481-93.
Uysal M. Serbest radikaller, lipid peroksitleri ve or- ganizmada prooksidan-oksidan dengeyi etkileyen koşullar. Klinik Gelişim 1998;11:336-41.
Gutteridge JM. Lipid peroxidation and antioxidants as biomarkers of tissue damage. Clin Chem 1995; 41(12 Pt 2):1819-28.
Gutteridge JM, Halliwell B. Free radicals and antiox- idants in the year 2000. A historical look to the future. Ann N Y Acad Sci 2000;899:136-47.
De Vecchi E, Pala MG, Di Credico G, Agape V, Paolini G, Bonini PA, et al. Relation between left ventricular function and oxidative stress in patients undergoing bypass surgery. Heart 1998;79:242-7.
Stocks J, Gutteridge JM, Sharp RJ, Dormandy TL. Assay using brain homogenate for measuring the antioxidant activity of biological fluids. Clin Sci Mol Med 1974;47:215-22.
Ohkawa H, Ohishi N, Yagi K. Assay for lipid perox- ides in animal tissues by thiobarbituric acid reaction. Anal Biochem 1979;95:351-8.
Gorog P, Kotak DC, Kovacs IB. Simple and specific test for measuring lipid peroxides in plasma. J Clin Pathol 1991;44:765-7.
Dawson-Saunders B, Trapp RG. Basic and clinical bio- statistics. 2nd ed. Norwalk, Connecticut: Appleton & Lange; 1994.
Yalçın AS. Antioksidanlar. Klinik Gelişim 1998;11: 342-6.
İşlekel H, Uğurlu B, Hazan E, Saydam N, Saydam O, Oto Ö, ve ark. Evaluation of lipid peroxidation and antioxidant status in myocardial tissue and coronary sinus blood of patients undergoing car- diopulmonary bypass. Türk Biyokimya Dergisi 1999; 24:5-13.
Carlucci F, Tabucchi A, Biagioli B, Simeone F, Scolletta S, Rosi F, et al. Cardiac surgery: myocardial energy balance, antioxidant status and endothelial function after ischemia-reperfusion. Biomed Pharmacother 2002;56:483-91.
Kim KB, Chung HH, Kim MS, Rho JR. Changes in the antioxidative defensive system during open heart operations in humans. Ann Thorac Surg 1994; 58:170-5.
Inal M, Alatas O, Kanbak G, Akyuz F, Sevin B. Changes of antioxidant enzyme activities during cardiopulmonary bypass. J Cardiovasc Surg 1999;40: 373-6.
Inal M, Alatas O, Kural T, Sevin B. Oxygen free rad- icals in erythrocytes during open heart operation. J Cardiovasc Surg 1994;35:147-50.
Starkopf J, Tamme K, Zilmer M, Talvik R, Samarutel J. The evidence of oxidative stress in cardiac surgery and septic patients: a comparative study. Clin Chim Acta 1997;262:77-88.
Starkopf J, Zilmer K, Vihalemm T, Kullisaar T, Zilmer M, Samarutel J. Time course of oxidative stress during open-heart surgery. Scand J Thorac Cardiovasc Surg 1995;29:181-6.
Hadjinikolaou L, Alexiou C, Cohen AS, Standbridge Rde L, McColl AJ, Richmond W. Early changes in plasma antioxidant and lipid peroxida- tion levels following coronary artery bypass surgery: a complex response. Eur J Cardiothorac Surg 2003;23:969-75.
McColl AJ, Keeble T, Hadjinikolaou L, Cohen A, Aitkenhead H, Glenville B, et al. Plasma antioxi- dants: evidence for a protective role against reactive oxygen species following cardiac surgery. Ann Clin Biochem 1998;35(Pt 5):616-23.
Vaughan-Sarrazin MS, Hannan EL, Gormley CJ, Rosenthal GE. Mortality in Medicare beneficiaries following coronary artery bypass graft surgery in states with and without certificate of need regula- tion. JAMA 2002;288:1859-66.