Журнал «Медицина неотложных состояний» Том 20, №1, 2024

Сучасні воєнні дії створили унікальні проблеми для медичної, хірургічної та реабілітаційної допомоги військовозобов’язаним, які отримали поранення в бойових умовах. Досвід надання медичної допомоги учасникам бойових дій показав, що дисфункція ендокринної системи є провідною патогенетичною ланкою, яка впливає на організм людини при бойовій хірургічній травмі та посттравматичних стресових розладах. Основний патогенетичний механізм травми й посттравматичних стресових розладів пов’язаний з дисфункцією гіпоталамо-гіпофізарно-надниркової осі. У нейроендокринних механізмах розвитку стресу беруть участь гормони: кортизол, дегідроепіандростерон, адреналін, норадреналін, які регулюють і контролюють реакцію на стрес, а також відображають стадійність його перебігу й адаптивні можливості організму. Дисфункція гіпоталамо-гіпофізарно-тиреоїдної осі має велике значення в регуляції як гострого, так і хронічного стресу з клінічним розвитком різних захворювань щитоподібної залози: гіпертиреозу, хвороби Грейвса, автоімунних тиреопатій, зобної трансформації. У зв’язку з цим має практичне значення дослідження в клініці основних показників гіпофізарно-надниркової і гіпофізарно-тиреоїдної функції, моніторинг функції надниркових залоз і щитоподібної залози. Корекція цих порушень, лікування і реабілітація пацієнтів з бойовими травматичними пошкодженнями повинні здійснюватися з урахуванням спеціалізованої ендокринологічної допомоги, що буде актуальним для військової медицини України в наступні роки.

The modern hostilities have created the unique challenges for medical, surgical and rehabilitation assistance to people liable for military service who have sustained injuries in the battle conditions. The experience of providing medical care for participants of modern military operations has shown that endocrine dysfunction is a leading pathogenetic link that affects the human body in combat surgical trauma and post-traumatic stress disorders. The main pathogenetic mechanism of trauma and post-traumatic stress disorders is associated with dysfunction of the hypothalamic-pituitary-adrenal axis. Hormones such as cortisol, dehydroepiandrosterone, adrenaline and noradrenaline are involved in the neuroendocrine mechanisms of stress development. These hormones regulate and control the stress response, reflecting the stages of its course and the adaptive capacities of the organism. Dysfunction of the hypothalamic-pituitary-thyroid axis has a significant importance in the regulation of both acute and chronic stress accompanied by the clinical development of various thyroid disorders such as hyperthyroidism, Graves’ disease, autoimmune thyroidopathies and nodular transformation. Therefore, the practical significance lies in the clinical studying the key indicators of pituitary-adrenal and pituitary-thyroid function, monitoring the function of the adrenal glands and the thyroid. Correction of these disorders, the treatment and rehabilitation of patients with combat-related traumatic injuries should be carried out with specialized endocrinological assistance. This approach will be relevant for military medicine in Ukraine in the following years.

бойова хірургічна травма; посттравматичний стресовий розлад; ендокринна дисфункція

combat-related surgical injures; post-traumatic stress disorder; endocrine dysfunction

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