EVALUATING STRESS ADAPTIVITY IN WOMEN WITH COMBINED GYNAECOLOGICAL AND EXTRAGENITAL SURGICAL PATHOLOGY DURING COMBINED SURGERIES

Aim. To improve the results of surgical treatment of women with gynecological and extragenital combined surgical pathology by determining the state of hormonal homeostasis of stress reactivity of patients in order to develop and implement a rational surgical and anesthetic procedure for performing combined surgery. Material and Methods. Studying of the indicators of hormonal homeostasis of stress reactivity in pre- and postoperative periods in 53 women with gynecological and extragenital combined surgical pathology, which were divided into two groups: the first group was 31 women operated for gynecological pathology, the second group - 22 women with combined operations. Results and Discussion. The results showed that in the preoperative period, in patients with planned simultaneous operations, the blood level of cortisol was significantly higher than in healthy women (control group). Elevated concentrations of cortisol on the eve of simultaneous operations were defined in 18.2% of cases, which are characterized by high tension of adaptive reactions in the preoperative period. In turn, the reduction of cortisol secretion in patients who underwent simultaneous operations with respect to the control group characterizes the efficiency of anesthetic management and nociceptive protection. Changes in the secretion of cortisol in the blood serum of women surveyed are not reliable and indicative for determining the manifestations of surgical stress, given that the average stress-assosiated hormone did not extend beyond the reference standards. The concentration of melatonin in women with simultaneous operations tended to increase in the first and third postoperative day, which can be explained by the protective function of the universal adaptogen. Increasing concentrations of melatonin are due to the volume and nature of the surgery and the individual ability of the organism for antistress protection. This universal adaptogen can be a diagnostic marker for recovery and normalization of the patient's condition. Conclusion. Changes in secretion of stress-related hormones in women with gynecological and simultaneous operations represent both tension and relaxation adaptive responses that require individualization of preoperative preparation and postoperative period considering the nature of the determined hormonal disorders. Keywords: women with gynecological and extragenital combined surgical pathology, hormonal homeostasis, stress reactivity, simultaneous surgery