Kawasaki Takashi, Sata Takeyoshi
Department of Anesthesiology, School of Medicine, University of Occupational & Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8555, Japan.
J UOEH. 2011 Jun 1;33(2):123-37. doi: 10.7888/juoeh.33.123.
Innate immunity plays a pivotal role in host defense. The trauma of major surgery induces a variety of immunologic alterations in patients, which can lead to subsequent increased susceptibility to postoperative infections. Surgical stress inhibits innate immunity from the time of incision until about the first postoperative day. This is an alert period with susceptibility to bacterial infections. Normal patients regain innate immunity in the first postoperative day. The absence of recovery of innate immunity may cause susceptibility to infection and eventually lead to postoperative complications. Surgical stress causes catabolism, pain, ileus, nausea and vomiting, immunosuppression, increase of cardiac demands and coagulation cascade, and pulmonary dysfunction. Perioperative treatment or remedy will affect these surgical responses. Prevention of surgical site infections (SSI) is very important for clinicians. In the past, we worked with sterilization techniques, prophylactic antibiotics and environmental support such as maintaining body temperature and supplying a high concentration of oxygen. The goal of further clinical studies must be to establish the immunomodulating property of the individual, which is very important for controlling innate immunity and inflammation in each patient. The strategy for minimizing post-surgical infections is to optimize the immune response by maintaining homeostasis through nutritional support, and to reduce the surgical trauma by using minimal invasive surgery, which consequently reduces the stress response and immunesupression.
先天免疫在宿主防御中起关键作用。大手术创伤会在患者身上引发多种免疫改变，这可能导致术后对感染的易感性增加。手术应激从切口时起直至术后第一天左右都会抑制先天免疫。这是一个对细菌感染易感的警戒期。正常患者在术后第一天恢复先天免疫。先天免疫未恢复可能导致易感染，并最终引发术后并发症。手术应激会导致分解代谢、疼痛、肠梗阻、恶心和呕吐、免疫抑制、心脏需求增加和凝血级联反应以及肺功能障碍。围手术期治疗或补救措施会影响这些手术反应。预防手术部位感染（SSI）对临床医生非常重要。过去，我们采用了灭菌技术、预防性抗生素以及诸如维持体温和提供高浓度氧气等环境支持措施。进一步临床研究的目标必须是确定个体的免疫调节特性，这对于控制每位患者的先天免疫和炎症非常重要。将术后感染降至最低的策略是通过营养支持维持内环境稳定来优化免疫反应，并通过使用微创手术减少手术创伤，从而降低应激反应和免疫抑制。
