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W jaki sposób palenie papierosów wpływa na proces gojenia ran?

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Palenie tytoniu szkodliwie wpływa na proces natlenienia tkanek, osłabia odpowiedź immunologiczną organizmu, a także zaburza proces produkcji kolagenu. Nikotynizm prowadzi również do powikłań pooperacyjnych, a także do powstawania dużej blizny. 18 listopada obchodzimy Światowy Dzień Rzucania Palenia.

Palenie ma negatywny wpływ na niemal wszystkie narządy w ludzkim ciele i może być przyczyną chorób serca, udaru mózgu, raka płuc czy cukrzycy. Nikotyna upośledza również proces gojenia się ran na wielu etapach, a także negatywnie wpływa na kondycję skóry.

Palenie papierosów upośledza transport tlenu do rany

Prawidłowe gojenie się ran zależy m.in. od zdolności organizmu do transportu natlenionej krwi i innych składników odżywczych do rany. Tymczasem w tytoniu znajduje się wiele chemikaliów – nikotyna, tlenek węgla czy cyjanowodór – które zwężają naczynia krwionośne i zaburzają dostarczenie tlenu do tkanek. Tlenek węgla, który wytwarza się podczas palenia, wchłaniany jest do krwioobiegu. Tam łączy się z hemoglobiną odpowiedzialną za transport tlenu w całym organizmie, która wystawiona na szkodliwe działanie papierosów, zmniejsza swoją zdolność do przenoszenia tlenu. Zwężone naczynia krwionośne utrudniają hemoglobinie dotarcie do wszystkich obszarów ciała. Nikotyna zabija również płytki krwi i generuje ryzyko powstania skrzepów. Skrzepy blokują naczynia krwionośne utrudniając w ten sposób gojenie się uszkodzonego obszaru ciała.

Zaburzone funkcje odpornościowe organizmu

Zdrowy układ odpornościowy jest podstawą do poradzenia sobie organizmowi z infekcją bakteryjną. Tymczasem nikotyna zmniejsza liczbę i aktywność komórek odpornościowych, co zwiększa ryzyko zakażenia rany. Substancje chemiczne zawarte w dymie papierosowym mogą ograniczać działanie neutrofili, komórek krwi zwalczających infekcje. Palenie powoduje ponadto zaburzenia w przepływie krwi, co sprawia, że komórki odpornościowe nie migrują do rany i nie chronią jej przed bakteriami.

Palenie tytoniu generuje ryzyko powikłań pooperacyjnych

Wiele badań przeprowadzonych na całym świecie pokazuje, że palenie tytoniu generuje ryzyko wystąpienia powikłań pooperacyjnych związanych z raną. W jednym z badań (Manassa i wsp., 2003) udowodniono iż u pacjentów, którzy poddali się plastyce powłok brzusznych, aż u 48 proc. palaczy doszło do martwicy tkanek, łuszczenia się skóry lub infekcji rany w porównaniu z zaledwie 15 proc. osób niepalących.

Palenie tytoniu może również wpłynąć na wydłużenie się procesu gojenia rany pooperacyjnej, prowadzić do nieszczelności zespoleń, opóźnionego zrastania się złamanych kości, osteoporozy czy częstszych złamań.  Substancje chemiczne pochodzące z palenia papierosów mogą również powodować krwawienie z rany, a także nasilenie stanu zapalnego rany pooperacyjnej, co może zwiększać dolegliwości bólowe. U palaczy ból może ponadto utrzymywać się przez dłuższy czas.

Powikłania ran, które następują u palaczy skutkują dłuższym pobytem w szpitalu, ryzykiem przeprowadzenia powtórnej operacji i większymi kosztami dla systemu opieki zdrowotnej.

Wpływ palenia na stan skóry i powstawanie blizn

Palenie papierosów sprzyja szybszemu starzeniu się skóry i pogarsza jej kondycję. Szkodliwe substancje w papierosach zaburzają proces produkcji kolagenu i elastyny. Papierosy obniżają poziom estrogenów w organizmie. W związku z tym u palaczy obserwuje się znaczne przesuszenie skóry oraz utratę jej elastyczności i jędrności. Skóra palaczy jest również bardziej wrażliwa, niż u osób niepalących. Na twarzy pojawiają się teleangiektazje, a cera jest bardziej ziemista. Ponadto palenie może być czynnikiem rozwoju łuszczycy, a każdy zapalony papieros może powodować szybszą remisję tej choroby.

Palenie prowadzi również do wolniejszego tworzenia się nowej tkanki i nasilonego bliznowacenia. Substancje zawarte w dymie oddziałują na namnażanie oraz migrację komórek tkanki łącznej, czyli fibroblastów, które odpowiedzialne są za produkowanie „naprawczych” białek. Pod wpływem dymu tytoniowego jednak – zamiast penetrować w głąb rany – odkładają się one na brzegach, prowadząc do powstania dużej blizny. Ponadto palenie osłabia produkcję kolagenu, co ma zasadnicze znaczenie w kształtowaniu się blizny.

Jak rzucenie palenia wpłynie na proces gojenia się ran?

Badanie Światowej Organizacji Zdrowia, Uniwersytetu w Newcastle w Australii i Światowej Federacji Stowarzyszeń Anestezjologów pokazuje, że każdy tydzień bez tytoniu znacznie poprawia przepływ krwi w całym ciele do najważniejszych narządów. Z danych WHO wynika, że osoby, które rzuciły palenie na około 4 tygodnie lub dłużej przed operacją, mają mniejsze ryzyko rozwoju powikłań pooperacyjnych. Natomiast palenie nawet jednego papierosa dziennie po operacji znacznie zmniejsza zdolność organizmu do dostarczania niezbędnych składników odżywczych do rany pooperacyjnej.

Wraz z rzuceniem palenia organizm zaczyna regenerować się po szkodliwych skutkach, jakie wywołała w nim nikotyna. Już okres od dwóch tygodni do trzech miesięcy bez papierosa przywraca przepływ krwi do normy, więc więcej tlenu i substancji odżywczych dociera do rany, przyspieszając proces gojenia..

Źródła:

wounds-uk.com, woundsource.com, biotechnologia.pl, phie.pl, WHO, Forum Leczenia Ran

 

Przeczytaj także: Badanie: e-papierosy mogą negatywnie wpływać na proces gojenia ran

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