从卡斯伯特森到快速康复外科：70年来在减轻外科手术患者应激方面取得的进展。
From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients.
作者信息
Wilmore Douglas W
机构信息
Department of Surgery, Brigham and Women's Hospital and the Harvard Medical School, Boston Massachusetts 02115, USA.
出版信息
Ann Surg. 2002 Nov;236(5):643-8. doi: 10.1097/00000658-200211000-00015.
OBJECTIVE
To evaluate the evolution of knowledge concerning the stress response in surgical patients and to determine the therapeutic benefit of stress reduction therapy.
SUMMARY BACKGROUND DATA
The stress response in surgical patients is associated with tissue catabolism, organ failure, and prolonged recovery. Understanding the neural-hormonal basis for these events has stimulated efforts to attenuate these undesirable effects. A review of the results of these efforts is important for the application of stress reduction therapy and further improvement of surgical care.
METHODS
Medline was searched from 1980 to the present using the terms "stress response," "neural-hormonal response," "fast track surgery," and "outcome in surgical patients." These papers were reviewed along with historical information relating to early descriptions of metabolic and stress responses in surgical patients.
RESULTS
Improved understanding of the stress response in surgical patients has occurred over the past 70 years. Multiple examples of stress reduction associated with decreased morbidity and mortality are reported.
CONCLUSIONS
Reduction of stress in surgical patients has improved outcome. The use of stress reduction techniques will continue to expand and contribute to the improvement of future surgical care.
目的
评估外科患者应激反应相关知识的演变，并确定应激减轻疗法的治疗益处。
总结背景数据
外科患者的应激反应与组织分解代谢、器官衰竭及恢复时间延长有关。了解这些事件的神经 - 激素基础促使人们努力减轻这些不良影响。回顾这些努力的结果对于应激减轻疗法的应用及外科护理的进一步改善具有重要意义。
方法
使用“应激反应”“神经 - 激素反应”“快速康复外科”和“外科患者的结局”等术语，检索1980年至今的Medline数据库。这些论文与有关外科患者代谢和应激反应早期描述的历史信息一同进行了综述。
结果
在过去70年里，对外科患者应激反应的理解有所改善。报告了多个与发病率和死亡率降低相关的应激减轻实例。
结论
减轻外科患者的应激可改善结局。应激减轻技术的应用将持续扩展，并有助于未来外科护理的改善。
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