Gipoergoz

Description:

We met a concept of a gipoergoz (power insufficiency of an organism) for the first time in work S. N. Efuni and V. A Shpektor (1986). Authors understand discrepancy between requirement of an organism as power insufficiency (fabrics, body, a cell) in energy and that limited amount of makroerg/ATP / which can be used for maintenance of structural integrity and functional activity of fabric or body at present.

Gipoergoz's symptoms:

The symptomatology is defined by a basic disease against the background of which there was a power insufficiency.

Gipoergoz's reasons:

It is known that power insufficiency - the result practically of any pathological process including which reached a critical level when there is a multiorgan insufficiency connected with exhaustion of energy resources of a cell and a limit form of a fabric hypoxia (Sechcha of P.B. 1987) S. N. Efuni and V. A. Shpektor (1986), considering problems of power insufficiency, raise a question of need of review of the existing ideas of hypoxemic states and, in particular, a fabric hypoxia. As authors note, not everyone гипоэргоз is a consequence only of oxygen insufficiency - hypoxias. It can arise at a lack of substrates of oxidation of a cell (substrate гипоэргоз) or inhibition of enzymes of a cell (enzymatic гипоэргоз) at normal or even raised fabric ro2.

Gipoergoz's treatment:

There are two ways of power recovery: enteral and parenteral, and each of them has the pluses and minuses. Long parenteral food is capable to provide an organism with energy and proteins, however it is noted that at long parenteral food are observed a mucosal atrophy, suppression of neutrophylic and lymphocytic functions, antibacterial protection of intestines, increase in permeability of an intestinal barrier. At the same time, according to the data of a number of authors received at an enterografiya in the 1st days after aggression at most of patients the expressed signs of a syndrome of intestinal insufficiency which are shown considerable restretching of loops of a small and large intestine liquid and gases, puffiness of a wall, increase in interloopy intervals, considerable oppression of electric activity of all departments of digestive tract come to light. At a research of the digesting and soaking up GITs functions the expressed decrease in nutritive absorption to 20–25% of norm is found in this category of patients. Thus, during this period the enteral way of administration of nutrients is blocked.

During certain time as power substrate high-strong solutions of glucose (40–50%) as the only source of nonprotein calories were used (the maximum dose makes no more than 5 g/kg of body weight a day). However use of large volumes of high-strong solutions of glucose is not recommended in connection with development at critical states of low tolerance to glucose as a result of blockade of secretion of insulin and emergence of the expressed hyperglycemia, a glucosuria, hyper osmolarity. The respiratory coefficient changes, the minute volume of breath increases, danger of activation of a liponeogenez and fatty infiltration of Yopecheni appears. Use of 5-10-15% of solutions of glucose cannot solve a power supply problem in connection with low power consumption and large volume of infusion.

Means with not split protein molecule (plasma, albumine, a protein) cannot be used as a parenteral energy source as owing to feature of a structure of a cellular membrane are not capable to get into a cell, and splitting of these proteins takes considerable time — from 18 to 60 days.

It is reasonable to apply these means (drugs) to maintenance of colloid osmotic pressure and normalization of a hemodynamics only at the expressed hypoproteinemia (less than 45-50 g/l) and hypoalbuminemias (less than 20-25 g/l). At the same time the dose of the entered albumine has to be rather high (30–40 g) significantly to affect blood protein content and a ratio between vascular and intersticial pools of protein. It is necessary to remember what after intravenous administration of albumine only 1/3 the entered doses remains in a vascular bed, and 2/3 quickly enough collect in interstitial space (danger of development or aggravation of intersticial hypostases). Only use of 20% of albumine allows to reduce this complication and to increase efficiency of treatment.

Proteinaceous hydrolyzates were widely used in clinical practice as nitrogen sources in the 50-80th years of last century. Their shortcomings were long half-life (so, and ITS digestion of protein took considerable time), Yonalichiye of some impurity, in particular gumiyonovy substances which served as the reason of post-infusional reactions.

In nutritsionny practice of disturbance of synthesis of protein are almost always caused rather by an inadequacy of mix of amino acids, than a lack of the mechanism of synthesis. Ribosomes of hepatocytes are not able to prolong the activity of creation of a proteinaceous chain if one or several amino acids in optimum time do not come to an organism. The amino acids entered at different times cannot be used for protein synthesis. They are deaminized and exposed to oxidation, mainly in a liver. Therefore mix of the amino acids entered into an organism at the same time is necessary for full power providing. In comparison with drugs about which we spoke earlier mix of amino acids is the physiologic substrate at once entering biochemical processes.

Existence of complex network of metabolic reactions clearly shows that amino acids not only are used as construction elements of protein, but also serve as predecessors of biosynthesis of a number of important biologically active compounds.