Resistance of the organism, general characteristics, types. Nonspecific resistance of the body Methods for increasing the effectiveness of adaptation

Resistance (from lat. resister - resist, resist) - the body’s resistance to the action of extreme stimuli, the ability to resist without significant changes in the constancy of the internal environment; this is the most important qualitative indicator of reactivity;

Nonspecific resistance represents the body’s resistance to damage (G. Selye, 1961), not to any individual damaging agent or group of agents, but in general to damage, to various factors, including extreme ones.

It can be congenital (primary) and acquired (secondary), passive and active.

Congenital (passive) resistance is determined by the anatomical and physiological characteristics of the organism (for example, the resistance of insects, turtles, due to their dense chitinous cover).

Acquired passive resistance occurs, in particular, with serotherapy and replacement blood transfusion.

Active nonspecific resistance is determined by protective-adaptive mechanisms and occurs as a result of adaptation (adaptation to the environment), training to a damaging factor (for example, increased resistance to hypoxia due to acclimatization to a high-mountain climate).

Nonspecific resistance is provided by biological barriers: external (skin, mucous membranes, respiratory organs, digestive apparatus, liver, etc.) and internal - histohematic (blood-brain, hemato-ophthalmic, hematolabyrinthine, hematotesticular). These barriers, as well as biologically active substances contained in fluids (complement, lysozyme, opsonins, properdin) perform protective and regulatory functions, maintain the optimal composition of the nutrient medium for the organ, and help maintain homeostasis.

FACTORS REducing NON-SPECIFIC RESISTANCE OF THE ORGANISM. WAYS AND METHODS OF ITS INCREASE AND STRENGTHENING

Any impact that changes the functional state of regulatory systems (nervous, endocrine, immune) or executive (cardiovascular, digestive, etc.) leads to a change in the reactivity and resistance of the body.

Factors that reduce nonspecific resistance are known: mental trauma, negative emotions, functional inferiority of the endocrine system, physical and mental fatigue, overtraining, fasting (especially protein), malnutrition, lack of vitamins, obesity, chronic alcoholism, drug addiction, hypothermia, colds, overheating, painful injury, detraining of the body and its individual systems; physical inactivity, sudden changes in weather, prolonged exposure to direct sunlight, ionizing radiation, intoxication, previous diseases, etc.

There are two groups of pathways and methods that increase nonspecific resistance.

With a decrease in vital activity, loss of the ability to exist independently (tolerance)

2. Hypothermia

3. Ganglioblockers

4. Hibernation

When maintaining or increasing the level of vital activity (SNPS - a state of non-specifically increased resistance)

1 1. Training of basic functional systems:

Physical training

Hardening to low temperatures

Hypoxic training (adaptation to hypoxia)

2 2. Changing the function of regulatory systems:

Autogenic training

Verbal suggestion

Reflexology (acupuncture, etc.)

3 3. Non-specific therapy:

Balneotherapy, spa therapy

Autohemotherapy

Protein therapy

Nonspecific vaccination

Pharmacological agents (adaptogens - ginseng, Eleutherococcus, etc.; phytocides, interferon)

To the first group These include impacts through which resilience is increased due to the body’s loss of the ability to exist independently and a decrease in the activity of vital processes. These are anesthesia, hypothermia, hibernation.

When an animal in hibernation is infected with plague, tuberculosis, or anthrax, the diseases do not develop (they occur only after it awakens). In addition, resistance to radiation exposure, hypoxia, hypercapnia, infections, and poisoning increases.

Anesthesia increases resistance to oxygen starvation and electric current. In a state of anesthesia, streptococcal sepsis and inflammation do not develop.

With hypothermia, tetanus and dysentery intoxication are weakened, sensitivity to all types of oxygen starvation and to ionizing radiation is reduced; increased resistance to cell damage; allergic reactions are weakened, and in the experiment the growth of malignant tumors is slowed down.

In all these conditions, there is a deep inhibition of the nervous system and, as a consequence, of all vital functions: the activity of regulatory systems (nervous and endocrine) is inhibited, metabolic processes are reduced, chemical reactions are inhibited, the need for oxygen is reduced, blood and lymph circulation slows down, and the temperature drops body, the body switches to a more ancient metabolic pathway - glycolysis. As a result of the suppression of normal life processes, active defense mechanisms are switched off (or inhibited), and an areactive state arises, which ensures the body’s survival even in very difficult conditions. At the same time, he does not resist, but only passively tolerates the pathogenic effect of the environment, almost without reacting to it. This condition is called tolerability(increased passive resistance) and is a way for the body to survive in unfavorable conditions, when it is impossible to actively defend itself and avoid the action of an extreme irritant.

To the second group The following methods of increasing resistance while maintaining or increasing the level of vital activity of the body include:

Adaptogens are agents that accelerate adaptation to adverse effects and normalize disorders caused by stress. They have a broad therapeutic effect, increase resistance to a number of factors of a physical, chemical, biological nature. The mechanism of their action is associated, in particular, with their stimulation of the synthesis of nucleic acids and proteins, as well as with the stabilization of biological membranes.

By using adaptogens (and some other medications) and adapting the body to the action of unfavorable environmental factors, it is possible to create a special condition nonspecifically increased resistance - SNPS. It is characterized by an increase in the level of vital activity, mobilization of active defense mechanisms and functional reserves of the body, and increased resistance to the action of many damaging agents. An important condition for the development of SNPS is a dosed increase in the force of exposure to unfavorable environmental factors, physical activity, and the elimination of overloads, in order to avoid disruption of adaptive-compensatory mechanisms.

Thus, the organism that is more resistant is the one that resists better, more actively (SNPS) or is less sensitive and has greater tolerance.

Managing the reactivity and resistance of the body is a promising area of modern preventive and therapeutic medicine. Increasing nonspecific resistance is an effective way to generally strengthen the body.

Increased Nonspecific Resistance- This section of the treatment of infectious complications has been given particular importance in recent years. Protection against infection is associated with the production of antibodies and depends on the production and delivery to the site of bacterial contamination of cells capable of phagocytizing microorganisms and also destroying them through intracellular digestion. The delivery of phagocytes may be insufficient due to a decrease in blood flow through the affected area, a decrease in their concentration in the flowing blood, or the introduction of anti-inflammatory substances (glucocorticoids, salicylates, etc.). Phagocytosis by neutrophils and mononuclear phagocytes of the reticuloendothelial system depends mainly on the presence of specific antibodies and complement in the serum and tissue fluids. Loss of protein due to exhaustion or starvation, blood loss or suppuration reduces the ability to synthesize antibodies and disrupts the inflammatory

Reaction. Vitamin deficiency also reduces antibody synthesis. All these conditions lead to a decrease in resistance to developing infection. Therefore, measures to increase non-specific resistance include, first of all, stimulation of protein metabolism, erythro- and leukopoiesis, antibody production, inflammatory response, etc. For these purposes, high-calorie enteral and parenteral nutrition, albumin and gamma globulin, anabolic drugs, pyrimidine derivatives, vitamins, transfusions of whole blood and leukemia, zymosan, restim, interferon and other drugs.

Among the indicators nonspecific resistance In the immediate postoperative period, we attached great importance to nitrogen and energy balance. In a special study of parenteral nutrition, it was found that daily nitrogen losses after many interventions are very significant. For example, after plastic surgery of a ventricular septal defect in the heart under conditions of artificial circulation, they averaged 24 g, which is 1.5 times higher than the daily nitrogen loss after resection of the esophagus (16 g), 2 times after resection of the stomach (12 g) and 4.8 times after appendectomy (5 g). As the invasiveness of the intervention increased, nitrogen deficiency increased, which led to increasing hypoproteinemia. Oral, tube and rectal administration of nutrients could not eliminate the negative nitrogen balance due to intestinal paresis or atony, poor absorption, and anorexia. With severe intoxication by tissue autolysis products and toxic substances resulting from metabolic disorders, hypoproteinemia increased. As a result of studying metabolism in cases of so-called wound exhaustion, it was found that the basis of the latter is protein starvation, which arose as a result of a catabolic post-stress reaction and a violation of protein resynthesis in the liver and other organs. Along with this, the synthesis of digestive enzymes was disrupted, food digestion worsened, and the process of amino acids entering the blood and tissues slowed down. The external manifestation of protein deficiency was hypoproteinemia. She pointed to the depletion of organs and tissues in plastic material and a decrease in immunogenesis. Thus, hypoproteinemia characterized reduction of nonspecific resistance.

During protein starvation, the production of ascorbic acid, enzymes, hormones, immune bodies was disrupted, the detoxification function of the liver and intestinal motility suffered, which led to its atony or paresis, disturbances of trophism and colloid-osmotic balance (edema) developed, metabolic acidosis deepened, etc.

Typically, the infectious complication was accompanied by dysproteinemia: a decrease in the level of albumin and an increase in the content of gamma globulins. At the same time, the albumin-globulin ratio changed significantly, which served not only as a diagnostic, but also as a prognostic sign.

For stimulation of nonspecific resistance gamma globulin or polyglobulin was administered intramuscularly daily at a dose of 3–6 g.

Dysproteinemia indicated that, under the influence of surgical trauma, changes occurred in the liver not only of a functional, but also of a morphological nature. They reached a maximum in II and returned to normal during treatment in weeks V - VII. Changes in protein fractions were directly related and proportional to the severity of the surgical intervention.

One of the causes of volemic disorders in patients with septic conditions is a decrease in the volume of circulating albumin. These changes are of a phase nature. In this regard, an indispensable component of infusion therapy in the treatment of infectious complications should be combinations of preparations of whole and split proteins: combinations of hydrolysates with 5 - 15% solutions of albumin, protein, native plasma. Nitrogen deficiency is most often normalized at the rate of 1 - 1.5 g of native protein per 1 kg of patient weight per day. In case of severe infection, due to a pronounced catabolic reaction, intravenous administration of 50 - 70 g of native protein does not eliminate hypoproteinemia. In these cases, it is necessary to combine protein mixtures with anabolic drugs and energy products.

Preparations of split proteins (protein hydrolysates, solutions of amino acids) are quickly removed from the bloodstream, utilized by tissues and, to a greater extent than solutions containing whole proteins, serve plastic purposes, stimulation of immunogenesis and erythropoiesis, and detoxification.

A study of basal metabolism - the most accessible criterion of energy balance - in patients with infectious complications showed that their daily energy expenditure is very significant. On average, they amounted to 2500 ± 370 cal per day in adults (35 - 40 cal per 1 kg of weight). In children, there was an even greater increase in basal metabolism (70 - 90 cal/kg), which, with a favorable course, returned to the original level no earlier than 10 - 12 days after surgery. Therefore, protein-carbohydrate mixtures were compiled at a rate of at least 35 cal/kg of body weight in adults and 75 cal/kg in children. The anabolic effect of the administered mixture depended on sufficient energy supply. However, this issue has not yet found a satisfactory solution. The difficulties are due to the following circumstances. The main most accessible source of energy - glucose - has a low energy value (4.1 cal/g). In this regard, there is a need to administer large quantities of concentrated hypertonic glucose solutions (20 - 60% 1 - 3 l), which increases the risk of phlebitis when using peripheral veins, requires constant alkalization of solutions (glucose solutions have a pH of 6.0 - 5.4 and below).

There are also other objections to the use of glucose as the sole source of energy during parenteral nutrition. Long-term intravenous infusions of glucose led to a decrease in the albumin-globulin ratio, inhibition of albumin synthesis, and dysproteinemia, which indicated a deterioration in the functional state of the liver. The negative side of using glucose is the need to administer large doses of insulin, which increases the risk of overhydration and promotes the transfer of amino acids from the liver to the muscles.

In addition, glucose is a good nutrient medium for yeast fungi, so combination with antibiotics leads to the development of candidiasis, which somewhat limits its use. The patient's energy supply should include, in addition to glucose, a complex of other drugs.

More often 20% glucose solutions are used. Insulin is administered at the rate of 1 unit per 4 - 5 g of dry matter glucose. 5 - 6% hexose phosphate, sorbitol, 33% ethyl alcohol, diols and polyols are also used as an energy product. Invert sugar has undoubted advantages over glucose, which is quickly removed from the vein bed, less irritating to the intimate area, and does not require insulin.

The most powerful supplier of energy and a kind of biological stimulant are fat emulsions. We are talking about compensating for only part of the energy needs: complete replenishment from fat is unacceptable, primarily due to the danger of ketosis. The main advantage of intravenous fat administration is due to its high calorie content (9.3 cal/g), which makes it possible to fully meet the patient’s energy needs in a small volume of liquid. With the help of fat emulsions, essential nutritional factors such as highly unsaturated fatty acids and fat-soluble vitamins can be introduced. Fat emulsions do not have osmotic effects and do not have the listed disadvantages of glucose.

Currently, Intralipid (Sweden), Lipiphysan (France), Lipomul and Infonutrol (USA), Lipofundin (Germany), domestic fat emulsion LIPC and others are widely used. As a result of clinical trials, most authors came to the conclusion that fats in mixtures for parenteral nutrition should not exceed 30% of daily calories, 50% should be carbohydrates, 20% should be protein calories.

Our special studies have shown that in the postoperative period, with the development of an infectious complication, the processes of protein catabolism significantly prevail over anabolic ones. Replacement therapy with protein drugs was effective only if a complex of anabolic drugs was used simultaneously. To limit catabolic and stimulate anabolic processes, combinations of natural and synthetic androgenic hormones were used. No significant side effects or complications were observed from them. Typically, a 5% solution of testosterone propionate was used 1 - 2 ml intramuscularly or methylandrostenediol 50 - 100 mg sublingually, Nerobol 40 mg orally, retabolil 50 mg intramuscularly (after 3 - 6 days). For anabolic purposes, pyrimidine derivatives were also used (pentoxyl 0.4 or methyluracil 0.25 - 0.5 per day orally). The latter was also used intramuscularly in a 0.8% solution. A pronounced anabolic effect was noted; the content of total protein, albumin, and gamma globulins increased slightly.

From the literature (N.V. Lazarev, 1956; V.I. Rusakov, 1971, etc.) it is known that pyrimidine derivatives are close to the natural nitrogenous bases of nucleic acids and are stimulants of protein metabolism. In addition, it has been proven that they have a pronounced anti-inflammatory effect, reduce exudation processes, while simultaneously stimulating regeneration and phagocytosis. The authors also noted the ability of pentoxyl and methyluracil to enhance the production of antibodies and increase the effectiveness of antibiotics. In this regard, it is advisable to use pyrimidine derivatives.

Currently, in order to stimulate recovery processes, purine derivatives - potassium orotate - are also used. Pyrimidine and purine regeneration stimulants are low-toxic and have virtually no contraindications. They accelerate the synthesis of antibodies during chemotherapy and vaccination in cases of disorders of erythro- and leukopoiesis of a toxic-allergic nature. The best effect was obtained when they were combined with vitamin B 12, C, and folic acid.

Insulin is used to stimulate the synthesis of proteins and fats. In this case, round-the-clock monitoring of sugar levels in the blood and urine is necessary.

In recent years, polysaccharides of bacterial origin, isolated mainly from gram-negative microorganisms (acetoxan, candan, aurean, etc.), have been intensively studied. They have been found to be very successful activate nonspecific immunobiological reactivity of the body. In clinical practice, in the treatment of infectious complications, we more often used pyrogenal, pyrexal, and pyromene. Our experience with these drugs is limited, but first impressions are very encouraging.

The issues of vitamin metabolism and vitamin therapy are of great importance. As a result of many years of research and clinical observations, we came to the conclusion that a septic patient always developed toxic and sometimes nutritional vitamin deficiency. The result of acute vitamin A deficiency is a decrease in resistance to infection, mainly due to the loss of the epithelium's ability to prevent the penetration of microorganisms. The body's need for vitamins C and group B increased sharply during severe purulent intoxication, so complex therapy for infectious complications necessarily included ascorbic acid (intravenously - 10 g or more per day), vitamins A, B1, B2, Be, B12, folic and pantothenic acids. These drugs were administered daily parenterally, taking into account the degree of vitamin deficiency, but not less than in triple doses. In addition, patients received vitamins orally as part of medical nutrition and multivitamin-yeast therapy. Vitamin therapy stimulated the processes of regeneration and detoxification (S. M. Navashin, I. P. Fomina, 1974; I. Teodorescu-Exarcu, 1972, etc.).

In addition to the substitutive effect, blood and its individual components (albumin, gamma globulin, red blood cell mass, etc.) have a powerful stimulating effect. In this regard, blood transfusions in patients with infectious complications were carried out daily or every 1 to 2 days. Freshly heparinized blood was used more often. The best results were obtained with infusions of blood taken from previously immunized donors. In patients with severe intoxication and increasing anemia, direct transfusions have become an integral part of general treatment. This circumstance made it possible to exclude significant anemization. One of the main advantages of direct transfusion over citrate blood is its high replacement, stimulating and detoxifying function. Blood transfusions directly from donors gave an immediate and lasting effect. In some cases, direct transfusion was combined with an infusion of freshly citrated blood (no more than three days old). It is not advisable to use citrated blood with long shelf life. Special studies carried out in the clinic in 1965 (V.I. Nemchenko, I.M. Markelov) showed that citrated blood 3-4 days old and with long shelf life lost enzymatic activity, increased the risk of citrate intoxication, pyrogenic reactions, hemolysis, a number of unfavorable immunological changes. For direct transfusions, a device of an original design with a roller eccentric was used, as well as a finger device from the Krasnogvardeets association.

Recently, for septic complications, we do not use the classical method of direct blood transfusion, but transfusion of freshly stabilized blood taken from a donor into a vessel with heparin immediately before transfusion. The change in technique is due to ethical considerations and the risk of infection of the donor. A comparison of the survival rate of blood transfused directly from a donor and freshly stabilized blood did not reveal significant advantages of the former. In both cases, the percentage of functioning labeled erythrocytes by the end of the first day was no less than 95, and the half-life of life exceeded 25 days (Yu. N. Zhuravlev, L. I. Stavinskaya, 1970).

The largest amount of freshly stabilized blood transfused to one patient during the treatment period (pseudomonas bacteremia) was 14.2 liters. Repeated blood transfusions made it possible to maintain hemodynamic and immunological parameters at quite satisfactory levels, despite severe purulent intoxication (even at the height of infection). Direct blood transfusions or transfusions of freshly stabilized blood increased the phagocytic activity of leukocytes by an average of 8-9 times.

In recent years, along with whole blood, we have widely used its individual components or substitutes (washed erythrocytes, erythrocyte and leukocyte masses, thromboleukemia suspension, albumin, hydrolysates, etc.). This is caused not only by economic considerations, but also by the fact that the indications for whole blood transfusion are narrowing from year to year due to the risk of complications and side effects.

Thus, for the purposes of increasing nonspecific resistance and to eliminate metabolic disorders during an infectious complication, infusion therapy should include the following components (Table 17).

Antibacterial drugs and detoxification agents are administered according to indications. The total daily dose of liquid is 3450 - 5700 ml, including protein (in terms of native) - 85 - 150 g, glucose - 200 - 600 g, daily calorie content - 2000 - 4600 cal. In the absence of fat emulsions and alcohols - 2650 - 4000 ml and 1200 - 2800 cal, respectively.

The effectiveness of parenteral nutrition is most often assessed by nitrogen balance (nitrogen of administered drugs - total urine nitrogen according to Kjeldahl), weight, protein fractions, hematocrit, and basal metabolic rate. In addition, it is also necessary to take into account hemo-hydrobalance (blood loss, circulating blood volume, fluid loss through urine, respiration) and other indicators. All intravenous infusions should be performed under the control of central venous pressure (CVP). The volume of fluid administered is coordinated with the amount excreted (urine, vomit, exudation, suppuration). For detoxification purposes, a positive water balance is preferable. If the excretory function of the kidneys is not impaired, the calculation of the amount of fluid for infusion therapy in an adult is 40 ml/kg/24 hours, in a child - 80 - 100 ml/kg/24 hours. When the temperature rises during the HS, it is necessary to add fluids per day at the rate of ( on average) 10 - 14 ml per 1 kg of weight and 13% of daily calorie content.

In case of overhydration, dehydration therapy was carried out.

Clinical observations indicate the presence of frequent combinations of increased sensitization to staphylococcus and other pathogens with reduced general immunological reactivity. This necessitates desensitizing therapy, along with stimulating nonspecific defense mechanisms.
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Any impact that changes the functional state of regulatory systems - nervous, endocrine, immune or various executive systems (cardiovascular, digestive, metabolic reactions, etc.) leads to a change in the reactivity and resistance of the body. Factors that reduce nonspecific resistance are known: mental trauma, negative emotions, functional inferiority of the endocrine system, physical and mental fatigue, overtraining, fasting (especially protein), malnutrition, lack of vitamins, obesity, chronic alcoholism, drug addiction, hypothermia, colds, overheating, painful injury, detraining of the body and its individual systems; physical inactivity, sudden changes in weather, prolonged exposure to direct sunlight, intoxication, previous diseases, etc.

There are two groups of means and techniques that increase nonspecific resistance.

To the first group refers to the means by which increased stability is achieved at the cost of the body losing the ability to exist independently and reducing the activity of vital processes. These are anesthesia, hypothermia, hibernation.

In hibernating animals, when infected with plague, tuberculosis, or anthrax, the disease does not develop; it occurs only after awakening; increased resistance to radiation exposure, hypoxia, hypercapnia, infection, poisoning; hibernating mammals tolerate such low temperatures (rectal - 5°C), which are certainly fatal for a waking individual. During hibernation, animals release dermorphin and similar opioid peptides, which inhibit the reactions of the hypothalamic-pituitary system and the brain, many manifestations of reactivity are inhibited, metabolism is reduced, and the need for oxygen is reduced. A similar increase in resistance, in particular to surgical trauma, occurs in a person in a state of cold anesthesia - during iatrogenic hibernation.

In a state of anesthesia, resistance to oxygen starvation and electric current increases; streptococcal sepsis does not develop; When mustard gas and Lewisite are applied to the skin, inflammation does not develop. Under conditions of hypothermia, tetanus and dysentery intoxication are weakened, sensitivity to all types of oxygen starvation and to ionizing radiation is reduced; cell damage is reduced: in rats, for example, a burn with boiling water does not cause hyperemia, edema, or necrosis; allergic reactions are weakened; in the experiment, the growth of malignant tumors slows down.

In all these conditions, a deep inhibition of the nervous system and, as a result, of all vital functions develops: the activity of regulatory systems (nervous and endocrine) is inhibited, metabolic processes are reduced, chemical reactions are inhibited, the need for oxygen is reduced, the work of transport systems is weakened - blood and lymph circulation, body temperature decreases, the body switches to a more ancient metabolic pathway - glycolysis. As a result of the suppression of normal life processes, active defense mechanisms are switched off (or inhibited), and an areactive state arises, which ensures the body’s survival even in very difficult conditions. At the same time, he does not resist, but only passively endures the pathogenic effect of the environment, almost without reacting to it. This state is called tolerance (I.A. Arshavsky) and is a way for the body to survive in unfavorable conditions, when it is impossible to actively defend itself and avoid the action of an extreme irritant.

To the second group include techniques for increasing resistance while maintaining or increasing the level of vital activity of the body:

· training of basic functional systems: physical training; hardening at low temperatures; hypoxic training (adaptation to hypoxia);

· changing the function of regulatory systems: autogenic training, hypnosis, verbal suggestion, reflexology (acupuncture, etc.);

· nonspecific therapy: balneotherapy, spa therapy, autohemotherapy, protein therapy, nonspecific vaccination, pharmacological agents - phytoncides, interferon, adaptogens (ginseng, eleutherococcus, dibazol and vitamin B 12 in a certain dosage, etc.).

The doctrine of adaptogens is associated with the name of N.V. Lazarev (1895-1974), who laid the foundations of the “pharmacology of a healthy person” and formulated the idea of an adaptogenic effect. Adaptogens include a number of herbal preparations: extracts from plants of ginseng, eleutherococcus, Manchurian aralia, Leuzea, zamanika, Chinese magnolia vine, radiola rosea (“golden root”), etc.; some products of animal origin (pantocrine); a number of synthetic drugs - benzimedazole derivatives (dibazole); vitamin B 12, etc.

Adaptogens are agents that accelerate adaptation to unfavorable factors, normalizing disorders caused by stress: they have a wide range of therapeutic effects, increase resistance to a wide range of factors of a physical, chemical, biological nature.

Eleutherococcus has the most pronounced adaptogenic effect. In experiments, it also has antitoxic, antimutagenic, and antiteratogenic effects. Eleutherococcus extract contains: eleutherosides A, B, C, D, E, F, with which its biological activity is mainly associated; vitamins C, E, beta-carotene (provitamin A); microelements Ca, P, K, Mg, Na, Fe, Al, Ba, Sr, B, Cu, Zn, Mn, Cr, Co, germanium.

It has been established that adaptogens and, in particular, Eleutherococcus stimulate not only adaptation reactions, but also compensatory reactions. Thus, in the experiment, cerebral ischemia and myocardial infarction occur more favorably against the background of the administration of Eleutherococcus.

The mechanism of action of adaptogens (eleutherococcus, dibazole, vitamin B 12) is associated, in particular, with their stimulation of the synthesis of nucleic acids and proteins and the stabilization of biological membranes.

By using adaptogens (and some other medications), as well as adapting the body to the action of unfavorable environmental factors, it is possible to form in the body state of nonspecifically increased resistance- SNPS (N.V. Lazarev). This condition is characterized by an increase in the level of vital activity, mobilization of active defense mechanisms and functional reserves of the body, and increased resistance to the action of many damaging agents.

An important condition for the development of SNHL is a gradual increase in loads, avoiding overloads, in order to avoid disruption of adaptive-compensatory mechanisms.

Phase nature of adaptation
The adaptation process is phase-based. The first phase is the initial one, characterized by the fact that during the initial impact of an external factor of unusual strength or duration, generalized physiological reactions arise that are several times greater than the needs of the body. These reactions occur uncoordinatedly, with great stress on organs and systems. Therefore, their functional reserve is soon depleted, and the adaptive effect is low, which indicates the “imperfection” of this form of adaptation. It is believed that adaptation reactions at the initial stage occur on the basis of ready-made physiological mechanisms. Moreover, programs for maintaining homeostasis can be innate or acquired (in the process of previous individual experience) and can exist at the level of cells, tissues, fixed connections in subcortical formations and, finally, in the cerebral cortex due to its ability to form temporary connections.
An example of the manifestation of the first phase of adaptation is the increase in pulmonary ventilation and minute blood volume during hypoxic exposure, etc. The intensification of the activity of visceral systems during this period occurs under the influence of neurogenic and humoral factors. Any agent causes activation of the hypothalamic centers in the nervous system. In the hypothalamus, information switches to efferent pathways that stimulate the sympathoadrenal and pituitary-adrenal systems. As a result, there is an increased release of hormones: adrenaline, norepinephrine and glucocorticoids. At the same time, disturbances in the differentiation of excitation and inhibition processes in the hypothalamus that arise at the initial stage of adaptation lead to disintegration of regulatory mechanisms. This is accompanied by disruptions in the functioning of the respiratory, cardiovascular and other autonomic systems.
At the cellular level, in the first phase of adaptation, catabolism processes intensify. Thanks to this, the flow of energy substrates, oxygen and building material enters the working organs.
The second phase is transitional to sustainable adaptation. It manifests itself under conditions of strong or prolonged influence of a disturbing factor, or complex influence. In this case, a situation arises when the existing physiological mechanisms cannot ensure proper adaptation to the environment. It is necessary to create a new system that creates new connections based on elements of old programs. Thus, under the influence of a lack of oxygen, a functional system is created based on oxygen transport systems.
The main place for the formation of new adaptation programs in humans is the cerebral cortex with the participation of thalamic and hypothalamic structures. The thalamus provides basic information. The cerebral cortex, due to its ability to integrate information, form temporary connections in the form of conditioned reflexes and the presence of a complex socially conditioned behavioral component, forms this program. The hypothalamus is responsible for the implementation of the autonomic component of the program set by the cortex. He carries out its launch and correction. It should be noted that the newly formed functional system is fragile. It can be “erased” by inhibition caused by the formation of other dominants, or extinguished due to non-reinforcement.
Adaptive changes in the second phase affect all levels of the body.
. At the cellular-molecular level, enzymatic shifts mainly occur, which make it possible for the cell to function under a wider range of fluctuations in biological constants.
. The dynamics of biochemical reactions can cause changes in the morphological structures of a cell that determine the nature of its work, for example, cell membranes.
. At the tissue level, additional structural, morphological and physiological mechanisms appear. Structural and morphological changes ensure the occurrence of the necessary physiological reactions. Thus, in high altitude conditions, an increase in the content of fetal hemoglobin was noted in human erythrocytes.
. At the level of an organ or physiological system, new mechanisms can act on the principle of replacement. If any function does not ensure the maintenance of homeostasis, it is replaced by a more adequate one. Thus, an increase in pulmonary ventilation during exercise can occur both due to the frequency and depth of breathing. The second option during adaptation is more beneficial for the body. Among the physiological mechanisms are changes in the activity of the central nervous system.
. At the organismal level, either the principle of substitution operates, or additional functions are connected, which expands the functional capabilities of the body. The latter occurs due to neurohumoral influences on the trophism of organs and tissues.
The third phase is the phase of stable or long-term adaptation. The main condition for the onset of this stage of adaptation is the repeated or prolonged action on the body of factors that mobilize the newly created functional system. The body moves to a new level of functioning. It begins to work in a more economical mode by reducing energy costs for inadequate reactions. At this stage, biochemical processes at the tissue level predominate. Decomposition products accumulating in cells under the influence of new environmental factors become stimulators of anabolic reactions. As a result of the restructuring of cellular metabolism, anabolic processes begin to prevail over catabolic ones. Active synthesis of ATP occurs from its breakdown products.
Metabolites accelerate the process of RNA transcription on DNA structural genes. An increase in the amount of messenger RNA causes activation of translation, leading to an intensification of the synthesis of protein molecules. Thus, the enhanced functioning of organs and systems affects the genetic apparatus of cell nuclei. This leads to the formation of structural changes that increase the power of systems responsible for adaptation. It is this “structural trace” that is the basis of long-term adaptation.

Signs of achieving adaptation
In its physiological and biochemical essence, adaptation is a qualitatively new state, characterized by increased resistance of the body to extreme influences. The main feature of the adapted system is economical operation, i.e. rational use of energy. At the level of the whole organism, a manifestation of adaptive restructuring is the improvement of the functioning of nervous and humoral regulatory mechanisms. In the nervous system, the strength and lability of the processes of excitation and inhibition increases, the coordination of nervous processes improves, and interorgan interactions are improved. A clearer relationship is established in the activity of the endocrine glands. “Adaptation hormones” - glucocorticoids and catecholamines - have a strong effect.
An important indicator of the adaptive restructuring of the body is an increase in its protective properties and the ability to quickly and effectively mobilize immune systems. It should be noted that with the same adaptation factors and the same adaptation results, the organism uses individual adaptation strategies.

Assessing the effectiveness of adaptation processes
In order to determine the effectiveness of adaptation processes, certain criteria and methods for diagnosing the functional states of the body have been developed. R.M. Baevsky (1981) proposed to take into account five main criteria: 1. Level of functioning of physiological systems. 2. The degree of tension of regulatory mechanisms. 3. Functional reserve. 4. Degree of compensation. 5. Balance of elements of the functional system.
Methods for diagnosing functional states are aimed at assessing each of the listed criteria. 1. The level of functioning of individual physiological systems is determined by traditional physiological methods. 2. The degree of tension of regulatory mechanisms is studied: indirectly by methods of mathematical analysis of heart rhythm, by studying the mineral-secretory function of the salivary glands and the daily periodicity of physiological functions. 3. To assess the functional reserve, along with the known functional load tests, the “adaptation cost” is studied, which is lower, the higher the functional reserve. 4. The degree of compensation can be determined by the ratio of specific and nonspecific components of the stress response. 5. To assess the balance of elements of a functional system, mathematical methods such as correlation and regression analysis, modeling using state space methods, and a systems approach are important. Currently, measuring and computing systems are being developed that allow dynamic monitoring of the functional state of the body and prediction of its adaptive capabilities.

Violation of adaptation mechanisms
Violation of the adaptation process is gradual:
. The initial stage is a state of functional tension of adaptation mechanisms. Its most characteristic feature is a high level of functioning, which is ensured by intense or prolonged tension of regulatory systems. Because of this, there is a constant danger of developing insufficiency phenomena.
. The later stage of the border zone is a state of unsatisfactory adaptation. It is characterized by a decrease in the level of functioning of the biosystem, mismatch of its individual elements, and the development of fatigue and overwork. The state of unsatisfactory adaptation is an active adaptive process. The body tries to adapt to the conditions of existence that are excessive for it by changing the functional activity of individual systems and the corresponding tension of regulatory mechanisms (increasing the “payment” for adaptation). However, due to the development of deficiency, disturbances extend to energy and metabolic processes, and optimal functioning cannot be ensured.
. The state of adaptation failure (breakdown of adaptation mechanisms) can manifest itself in two forms: pre-illness and disease.
. Pre-disease is characterized by the manifestation of initial signs of disease. This condition contains information about the localization of probable pathological changes. This stage is reversible, since the observed deviations are functional in nature and are not accompanied by significant anatomical and morphological changes.
. The leading symptom of the disease is the limitation of the body's adaptive capabilities.
The insufficiency of general adaptation mechanisms during illness is complemented by the development of pathological syndromes. The latter are associated with anatomical and morphological changes, which indicates the occurrence of foci of local wear of structures. Despite the specific anatomical and morphological localization, the disease remains a reaction of the entire organism. It is accompanied by the inclusion of compensatory reactions, representing a physiological measure of the body’s defense against the disease.

Methods for increasing the effectiveness of adaptation
They can be nonspecific and specific. Nonspecific methods for increasing the effectiveness of adaptation: active rest, hardening, optimal (average) physical activity, adaptogens and therapeutic dosages of various resort factors that can increase nonspecific resistance, normalize the activity of the main body systems and thereby increase life expectancy.
Let's consider the mechanism of action of nonspecific methods using adaptogens as an example. Adaptogens are means that carry out pharmacological regulation of the body's adaptive processes, as a result of which the functions of organs and systems are activated, the body's defenses are stimulated, and resistance to unfavorable external factors increases.
Increasing the effectiveness of adaptation can be achieved in various ways: with the help of stimulants-dopings or tonics.
. Stimulants, having a stimulating effect on certain structures of the central nervous system, activate metabolic processes in organs and tissues. At the same time, catabolism processes intensify. The effect of these substances manifests itself quickly, but it is short-lived because it is accompanied by exhaustion.
. The use of tonics leads to the predominance of anabolic processes, the essence of which lies in the synthesis of structural substances and energy-rich compounds. These substances prevent disturbances in energy and plastic processes in tissues, as a result the body’s defenses are mobilized and its resistance to extreme factors increases. The mechanism of action of adaptogens: firstly, they can act on extracellular regulatory systems - the central nervous system and the endocrine system, and also directly interact with cellular receptors of various types, modulate their sensitivity to the action of neurotransmitters and hormones). Along with this, adaptogens are able to directly affect biomembranes, affecting their structure, the interaction of the main membrane components - proteins and lipids, increasing the stability of membranes, changing their selective permeability and the activity of associated enzymes. Adaptogens can, penetrating into a cell, directly activate various intracellular systems. Based on their origin, adaptogens can be divided into two groups: natural and synthetic.
Sources of natural adaptogens are terrestrial and aquatic plants, animals and microorganisms. The most important adaptogens of plant origin include ginseng, Eleutherococcus, Schisandra chinensis, Aralia Manchurian, zamanikha, etc. A special type of adaptogens are biostimulants. This is an extract from aloe leaves, juice from Kalanchoe stems, peloidin, distillations of estuary and silt medicinal mud, peat (peat distillation), humisol (a solution of humic acid fractions), etc. Preparations of animal origin include: pantocrine, obtained from deer antlers ; rantarin - from reindeer antlers, apilak - from royal jelly. Many effective synthetic adaptogens are derived from natural products (petroleum, coal, etc.). Vitamins have high adaptogenic activity. Specific methods for increasing the effectiveness of adaptation. These methods are based on increasing the body's resistance to any specific environmental factor: cold, high temperature, hypoxia, etc.
Let's consider some specific methods using the example of adaptation to hypoxia.
. Using adaptation in high altitude conditions to increase the body's adaptive reserves. Staying in the mountains increases the “altitude ceiling,” i.e., resistance (resistance) to acute hypoxia. Various types of individual adaptation to hypoxia have been noted, including diametrically opposed ones, ultimately aimed at both economization and hyperfunction of the cardiovascular and respiratory systems.
. The use of various modes of hyperbaric hypoxic training is one of the most accessible methods of increasing high-altitude stability. At the same time, it has been proven that the adaptation effects after training in the mountains and in a pressure chamber with the same magnitude of hypoxic stimulus and equal exposure are very close. V.B. Malkin et al. (1977, 1979, 1981, 1983) proposed a method of accelerated adaptation to hypoxia, which makes it possible to increase altitude resistance in a minimum period of time. This method is called express training. It includes multiple stepwise hyperbaric chamber ascents with “platforms” at various heights and a descent to the “ground.” Such cycles are repeated several times.
. Pressure chamber adaptation during sleep should be recognized as a fundamentally new mode of hypoxic training. The fact that the training effect is formed during sleep has important theoretical significance. It forces us to take a fresh look at the problem of adaptation, the formation mechanisms of which are traditionally and not always rightfully associated only with the active, waking state of the body.
. The use of pharmacological means to prevent mountain sickness, taking into account the fact that in its pathogenesis the leading role belongs to disturbances in the acid-base balance in the blood and tissues and the associated changes in membrane permeability. Taking medications that normalize the acid-base balance should also eliminate sleep disorders in hypoxic conditions, thereby contributing to the formation of an adaptation effect. Such a drug is diacarb from the class of carbonic anhydrase inhibitors.
. The principle of interval hypoxic training when breathing a gas mixture containing from 10 to 15% oxygen is used to increase a person’s adaptive potential and to increase physical capabilities, as well as to treat various diseases such as radiation sickness, coronary heart disease, angina pectoris, etc. .

Resistance of the body is the body’s resistance to the action of various pathogenic factors (physical, chemical and biological).
The body's resistance is closely related to the body's reactivity (see).
The resistance of an organism depends on its individual, in particular constitutional, characteristics.
A distinction is made between nonspecific resistance of the body, i.e. the body’s resistance to any pathogenic influences, regardless of their nature, and specific, usually to a specific agent. Nonspecific resistance depends on the state of the barrier systems (skin, mucous membranes, reticuloendothelial system, etc.), on nonspecific bactericidal substances in the blood serum (phagocytes, lysozyme, properdin, etc.) and the pituitary gland-adrenal cortex system. Specific resistance to infections is provided by immune reactions.
In modern medicine, methods for increasing both specific and nonspecific resistance of the body- vaccination (see), autohemotherapy (see), protein therapy (see), etc.

The body's resistance (from the Latin resistere - to resist) is the body's resistance to the action of pathogenic factors, i.e. physical, chemical and biological agents that can cause a pathological condition.
The resistance of the organism depends on its biological, species characteristics, constitution, gender, stage of individual development and anatomical and physiological characteristics, in particular the level of development of the nervous system and functional differences in the activity of the endocrine glands (pituitary gland, adrenal cortex, thyroid gland), as well as the state of the cellular substrate responsible for the production of antibodies.
The body's resistance is closely related to the functional state and reactivity of the body (see). It is known that during hibernation, some animal species are more resistant to the effects of microbial agents, for example, to tetanus and dysentery toxins, pathogens of tuberculosis, plague, glanders, and anthrax. Chronic fasting, severe physical fatigue, mental trauma, poisoning, colds, etc. reduce the body's resistance and are factors predisposing to the disease.
There are nonspecific and specific resistance of the organism. Nonspecific body resistance is provided by barrier functions (see), the content in body fluids of special biologically active substances - complements (see), lysozyme (see), opsonins, properdin, as well as the state of such a powerful factor of nonspecific protection as phagocytosis (see). An important role in the mechanisms of nonspecific resistance the body plays adaptation syndrome (see). The specific resistance of the organism is determined by the species, group or individual characteristics of the organism under special influences on it, for example, during active and passive immunization (see) against pathogens of infectious diseases.
It is practically important that the body’s resistance can be enhanced artificially with the help of specific immunization, as well. also by administering convalescent serums or gamma globulin. Promotion nonspecific resistance the body has been used by folk medicine since ancient times (moxibustion and acupuncture, creation of foci of artificial inflammation, use of plant substances such as ginseng, etc.). In modern medicine, such methods of increasing the body's nonspecific resistance as autohemotherapy, protein therapy, and the introduction of antireticular cytotoxic serum have taken a strong place. Stimulation body resistance with the help of nonspecific influences is an effective way to generally strengthen the body, increasing its protective capabilities in the fight against various pathogens.