Doherty Thomas J
Department of Large Animal Clinical Sciences, The University of Tennessee College of Veterinary Medicine, 2407 River Drive, Knoxville, TN 37996, USA.
Vet Clin North Am Equine Pract. 2009 Aug;25(2):351-62. doi: 10.1016/j.cveq.2009.04.011.
Surgical manipulation of the intestines activates intestinal macrophages that release cytokines and nitric oxide, which results in inhibition of intestinal motility. Subsequent infiltration of circulating leukocytes into the intestinal wall contributes to cytokine and nitric oxide release and exacerbates ileus. Other factors contributing to ileus are endotoxemia; edema of the intestine wall subsequent to excessive fluid therapy; hypocalcemia; and long abdominal incisions. Because treatment of ileus with prokinetic drugs has not proven to be very effective, efforts should be directed at reducing its severity. Strategies which reduce the severity of ileus include pretreatment with a nonsteroidal anti-inflammatory drug, minimizing the length of the abdominal incision, reducing intestinal manipulation, intraoperative lidocaine infusion, correction of hypocalcemia, limiting the volume of intravenous fluids to prevent intestinal edema, and administration of alpha(2) antagonists.
肠道手术操作会激活肠道巨噬细胞，这些巨噬细胞会释放细胞因子和一氧化氮，从而导致肠道蠕动受到抑制。随后，循环白细胞浸润到肠壁中，促进细胞因子和一氧化氮的释放，并加重肠梗阻。导致肠梗阻的其他因素包括内毒素血症；过度液体治疗后肠壁水肿；低钙血症；以及腹部切口过长。由于使用促动力药物治疗肠梗阻尚未证明非常有效，因此应努力降低其严重程度。降低肠梗阻严重程度的策略包括使用非甾体抗炎药进行预处理、尽量缩短腹部切口长度、减少肠道操作、术中输注利多卡因、纠正低钙血症、限制静脉输液量以预防肠道水肿，以及给予α2拮抗剂。
