Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Clin Nutr. 2018 Feb;37(1):19-36. doi: 10.1016/j.clnu.2017.07.015. Epub 2017 Jul 29.
The gut has a major influence on the course of the human stress response in critical illness for several reasons; the quantity of its immune tissue, the extent of interface with the external environment, the expanse of the microbiome, and its access to the systemic circulation. In critical illness, it is not uncommon to lose mucosal barrier function, which exposes the host to the downside effects of luminal contents and epithelial cell regulation. In that setting, the microbiome is converted to a pathobiome, upregulation of metabolic and immune responses occurs, and homeostatic defense systems are compromised. Awareness of this process mandates that greater attention be given to the interplay between the gut and systemic responses, and that modulation of the gastrointestinal tract be considered in every therapeutic intervention in the critical care setting.
肠道对危重病患者的人类应激反应过程有重大影响，原因有几个：免疫组织的数量、与外部环境的接触程度、微生物组的范围，以及其进入全身循环的途径。在危重病中，黏膜屏障功能丧失并不罕见，这使宿主容易受到腔内容物和上皮细胞调节的不利影响。在这种情况下，微生物组转变为病理生物组，代谢和免疫反应上调，体内平衡防御系统受损。对这一过程的认识要求我们更加关注肠道和全身反应之间的相互作用，并在危重病治疗干预的每一个环节都考虑对胃肠道的调节。
