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术后肠梗阻的机制。

Mechanisms of postoperative ileus.

作者信息

Bauer A J, Boeckxstaens G E

机构信息

Department of Medicine/Gastroenterology, University of Pittsburgh, Pittsburgh, PA 15261, USA.

出版信息

Neurogastroenterol Motil. 2004 Oct;16 Suppl 2:54-60. doi: 10.1111/j.1743-3150.2004.00558.x.

Abstract

Postoperative ileus is an iatrogenic condition that follows abdominal surgery. Three main mechanisms are involved in its causation, namely neurogenic, inflammatory and pharmacological mechanisms. In the acute postoperative phase, mainly spinal and supraspinal adrenergic and non-adrenergic pathways are activated. Recent studies, however, show that the prolonged phase of postoperative ileus is caused by an enteric molecular inflammatory response and the subsequent recruitment of leucocytes into the muscularis of the intestinal segments manipulated during surgery. This inflammation impairs local neuromuscular function and activates neurogenic inhibitory pathways, inhibiting motility of the entire gastrointestinal tract. The mechanisms underlying the recruitment of the inflammatory cells, and their interaction with the intestinal afferent innervation, are discussed. Finally, opioids administered for postoperative pain control also contribute to a large extent to the reduction in propulsive gastrointestinal motility observed after abdominal surgery.

摘要

术后肠梗阻是腹部手术后出现的一种医源性病症。其病因涉及三种主要机制,即神经源性、炎症性和药理学机制。在术后急性期,主要是脊髓和脊髓上的肾上腺素能和非肾上腺素能通路被激活。然而,最近的研究表明,术后肠梗阻的迁延阶段是由肠道分子炎症反应以及随后白细胞募集到手术中被操作肠段的肌层所致。这种炎症损害局部神经肌肉功能并激活神经源性抑制通路,抑制整个胃肠道的蠕动。文中讨论了炎症细胞募集的潜在机制及其与肠传入神经支配的相互作用。最后,用于术后疼痛控制的阿片类药物在很大程度上也导致了腹部手术后观察到的胃肠道推进性蠕动减弱。

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