{"id":1981,"date":"2023-02-07T10:57:08","date_gmt":"2023-02-07T10:57:08","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=1981"},"modified":"2023-02-24T10:51:25","modified_gmt":"2023-02-24T10:51:25","slug":"3-1-shemija-mozga","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=1981","title":{"rendered":"3.1. ISHEMIJA MOZGA"},"content":{"rendered":"

\"\"<\/a><\/p>\n

\n

ETIOPATOGENEZA KAROTIDNE BOLESTI<\/h1>\n<\/h1>\n
\n

\n

3.1. ISHEMIJA MOZGA

<\/h3>\n<\/div>\n
\n

Ishemija mozga je metaboli\u010dki funkcionalni poreme\u0107aj, uzrokovan redukcijom cirkulacije, koji zavr\u0161ava morfolo\u0161kim o\u0161te\u0107enjem nervnih elemenata. Energetska kriza zavr\u0161ava depolarizacijom i smr\u0107u nervne \u0107elije.<\/h4>\n
    \n
  • Prema stepenu ishemi\u010dkih lezija razlikuju se dve zone ishemije: centralna ili nekroti\u010dna zona, i<\/li>\n
  • periferna ili zona ishemi\u010dne penumbre.<\/li>\n<\/ul>\n<\/div>\n

    \"\"<\/p>\n

    \n

    Ishemi\u010dki infarkt mozga: Zone ishemije su: <\/em>
    (a) Morfolo\u0161ki neizmenjena zona sa funkcionalnim smetnjama, <\/em>
    (b) Penumbra sa reverzibilnom ishemijom i edemom nervnog tkiva i <\/em>
    (c) Region ireverzibilne ishemi\u010dke nekroze.<\/em><\/p>\n

    \u00a0<\/em><\/p>\n<\/div>\n

    \"\"<\/p>\n

    \n

    Nekroti\u010dna<\/b><\/span> <\/b><\/span>zona<\/b><\/span> <\/b><\/span>sa<\/span> <\/span>protokom<\/span> <\/span>ispod<\/span> <\/span>10<\/span> <\/span>ml\/100g<\/span> <\/span>tkiva\/min.<\/span> <\/span>U<\/span> <\/span>centralnoj<\/span> <\/span>zoni<\/span> <\/span>ishemije<\/span> <\/span>postoji<\/span> <\/span>vazoparaliza<\/span> <\/span>i<\/span> <\/span>staza,<\/span> <\/span>a<\/span> <\/span>edem<\/span> <\/span>se<\/span> <\/span>razvija<\/span> <\/span>i<\/span> <\/span>vr\u0161i<\/span> <\/span>mehani\u010dki<\/span> <\/span>pritisak<\/span> <\/span>na<\/span> <\/span>zonu<\/span> <\/span>penumbre,<\/span> <\/span>\u010dime<\/span> <\/span>se,<\/span> <\/span>uz<\/span> <\/span>osloba\u0111anje<\/span> <\/span>toksi\u010dnih<\/span> <\/span>materija,<\/span> <\/span>\u0161iri<\/span> <\/span>zona<\/span> <\/span>nekroze.<\/span> <\/span>Ishemi\u010dki<\/span> <\/span>infarkt<\/span> <\/span>mozga<\/span> <\/span>se<\/span> <\/span>na<\/span> <\/span>bazi<\/span> <\/span>nekroze<\/span> <\/span>krvnih<\/span> <\/span>sudova<\/span> <\/span>i\/ili<\/span> <\/span>tokom<\/span> <\/span>reperfuzije<\/span> <\/span>mo\u017ee<\/span> <\/span>pretvoriti<\/span> <\/span>u<\/span> <\/span>hemoragi\u010dki<\/span> <\/span>infarkt.<\/span><\/p>\n

    U<\/b><\/span> <\/b><\/span>zoni<\/b><\/span> <\/b><\/span>penumbre<\/b><\/span> <\/b><\/span>protok<\/span> <\/span>je<\/span> <\/span>izme\u0111u<\/span> <\/span>10<\/span> <\/span>i<\/span> <\/span>20<\/span> <\/span>ml\/100g<\/span> <\/span>tkiva\/min.<\/span> <\/span>U<\/span> <\/span>zoni<\/span> <\/span>penumbre<\/span> <\/span>nema<\/span> <\/span>elektro<\/span>fi<\/span>zoiolo\u0161ke<\/span> <\/span>regulacije,<\/span> <\/span>ali<\/span> <\/span>su<\/span> <\/span>funkcije<\/span> <\/span>plazma<\/span> <\/span>membrane<\/span> <\/span>i<\/span> <\/span>jonske<\/span> <\/span>pumpe<\/span> <\/span>o\u010duvane.<\/span> <\/span>Redukcija<\/span> <\/span>protoka<\/span> <\/span>do<\/span> <\/span>10<\/span> <\/span>ml\/100g\/min,<\/span> <\/span>u<\/span> <\/span>trajanju<\/span> <\/span>do<\/span> <\/span>20<\/span> <\/span>minuta,<\/span> <\/span>ne<\/span> <\/span>dovodi<\/span> <\/span>do<\/span> <\/span>nekroti\u010dkih<\/span> <\/span>promena.<\/span> <\/span>Zato<\/span> <\/span>je<\/span> <\/span>zona<\/span> <\/span>ishemi\u010dne<\/span> <\/span>penumbre<\/span> <\/span>ciljno<\/span> <\/span>podru\u010dje<\/span> <\/span>na<\/span> <\/span>koje<\/span> <\/span>se<\/span> <\/span>usmerava<\/span> <\/span>terapija.<\/span> <\/span>Uslov<\/span> <\/span>je<\/span> <\/span>delimi\u010dno<\/span> <\/span>prisustvo<\/span> <\/span>cirkulacije<\/span> <\/span>da<\/span> <\/span>bi<\/span> <\/span>lek<\/span> <\/span>uop\u0161te<\/span> <\/span>dospeo<\/span> <\/span>do<\/span> <\/span>penumbre<\/span> <\/span>i<\/span> <\/span>da<\/span> <\/span>bi<\/span> <\/span>revaskularizacija<\/span> <\/span>imala<\/span> <\/span>smisla.<\/span> <\/span>Tkivo<\/span> <\/span>u<\/span> <\/span>zoni<\/span> <\/span>ishemi\u010dne<\/span> <\/span>penumbre,<\/span> <\/span>sposobno<\/span> <\/span>je<\/span> <\/span>za<\/span> <\/span>indukovanu<\/span> <\/span>vazodilataciju.<\/span><\/p>\n

    Mehanizmi<\/span> <\/span>koji<\/span> <\/span>dovode<\/span> <\/span>do<\/span> <\/span>smrti<\/span> <\/span>\u0107elije<\/span> <\/span>u<\/span> <\/span>ishemiji<\/span> <\/span>su:<\/span><\/p>\n

      \n
    • pove<\/b>\u0107anje<\/strong><\/span> <\/span>intracelularne<\/span> <\/span>koncentracije<\/span> <\/span>Ca2+,<\/span><\/strong><\/li>\n
    • acidoza<\/span> <\/span>zbog<\/span> <\/span>anaerobnog<\/span> <\/span>metabolizma,<\/span><\/strong><\/li>\n
    • nekontrolisano<\/span> <\/span>stvaranje<\/span> <\/span>slobodnih<\/span> <\/span>radikala<\/span> <\/span>i<\/span><\/strong><\/li>\n
    • proizvodnja<\/span> <\/span>lipidnih<\/span> <\/span>medijatora<\/span> <\/span>(derivata<\/span> <\/span>arahidonske<\/span> <\/span>kiseline:<\/span> <\/span>tromboksana<\/span> <\/span>A2,<\/span> <\/span><\/strong>p<\/strong>rostaglandina,<\/b><\/span> <\/b><\/span>leukotrijena,<\/b><\/span> <\/b><\/span>i<\/b><\/span> <\/b><\/span>faktora<\/b><\/span> <\/b><\/span>agregacije<\/b><\/span> <\/b><\/span>trombocita).<\/b><\/span><\/li>\n<\/ul>\n

      Ishemi\u010dko<\/span> <\/span>o\u0161te\u0107enje<\/span> <\/span>neurona<\/span> <\/span>prethodi<\/span> <\/span>o\u0161te\u0107enju<\/span> <\/span>glije<\/span> <\/span>i<\/span> <\/span>endotelijalnih<\/span> <\/span>\u0107elija.<\/span> <\/span>Nekroza<\/span> <\/span>neurona,<\/span> <\/span>je<\/span> <\/span>uzrokovana<\/span> <\/span>slobodnim<\/span> <\/span>radikalima,<\/span> <\/span>lipidnim<\/span> <\/span>medijatorima,<\/span> <\/span>agregacionim<\/span> <\/span>faktorima<\/span> <\/span>trombocita<\/span> <\/span>itd.<\/span> <\/span>Pri<\/span> <\/span>citolizi<\/span> <\/span>neurona<\/span> <\/span>osloba\u0111aju<\/span> <\/span>se<\/span> <\/span>toksi\u010dne<\/span> <\/span>supstance<\/span> <\/span>koje<\/span> <\/span>lediraju<\/span> <\/span>glijalne<\/span> <\/span>\u0107elije<\/span> <\/span>i<\/span> <\/span>vaskularno<\/span> <\/span>tkivo.<\/span> <\/span>Po\u0161to<\/span> <\/span>izme\u0111u<\/span><\/p>\n

      nastanka<\/span> <\/span>primarnog<\/span> <\/span>i<\/span> <\/span>kasnijih<\/span> <\/span>o\u0161te\u0107enja<\/span> <\/span>postoji<\/span> <\/span>vremenska<\/span> <\/span>latenca<\/span> <\/span>tu<\/span> <\/span>je<\/span> <\/span>prozor<\/span> <\/span>za<\/span> <\/span>primenu<\/span> <\/span>terapije<\/span> <\/span>koja<\/span> <\/span>spre\u010dava<\/span> <\/span>sekundarna<\/span> <\/span>o\u0161te\u0107enja.<\/span> <\/span>Manje<\/span> <\/span>izra\u017eenu<\/span> <\/span>ishemiju,<\/span> <\/span>u <\/span>penumbri,<\/span> <\/span>prati<\/span> <\/span>umereno<\/span> <\/span>smanjenje<\/span> <\/span>nivoa<\/span> ATP<\/span> <\/span>izla\u017eu\u0107i<\/span> <\/span>\u0107elije<\/span> <\/span>nepovoljnim,<\/span> <\/span>ali<\/span> <\/span>prolaznim,<\/span> <\/span>funkcionalnim<\/span> <\/span>promenama.<\/span><\/p>\n<\/div>\n

      \n

      Patolo\u0161ka dinamika hemoragi\u010dne infrakcije na bazi ishemi\u010dkog infarkta mozga. Fragmentacija embolusa mo\u017ee da dovede do regresije ishemije. Revaskularizacija sa popravljanjem perfuzionog pritiska u zoni ishemi\u010d- ke nekroze mo\u017ee da izazove hemoragi\u010dni infarkt mozga.<\/em><\/p>\n<\/div>\n


      \n<\/p>\n","protected":false},"excerpt":{"rendered":"

      ETIOPATOGENEZA KAROTIDNE BOLESTI 3.1. ISHEMIJA MOZGA Ishemija mozga je metaboli\u010dki funkcionalni poreme\u0107aj, uzrokovan redukcijom cirkulacije, koji zavr\u0161ava morfolo\u0161kim o\u0161te\u0107enjem nervnih elemenata. Energetska kriza zavr\u0161ava depolarizacijom i smr\u0107u nervne \u0107elije. Prema stepenu ishemi\u010dkih lezija razlikuju se dve zone ishemije: centralna ili nekroti\u010dna zona, i periferna ili zona ishemi\u010dne penumbre. Ishemi\u010dki infarkt mozga: Zone ishemije su: (a) […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1981","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n3.1. 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