Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston 4006, Queensland, Australia; Faculty of Medicine, The University of Queensland, St Lucia 4067, Queensland, Australia.
Faculty of Medicine, The University of Queensland, St Lucia 4067, Queensland, Australia; Department of Endocrinology and Diabetes, Princess Alexandra Hospital, Ipswich Road, Woolloongabba 4102, Queensland, Australia; Endocrine Hypertension Research Centre, The University of Queensland Diamantina Institute, Ipswich Road, Woolloongabba 4102, Queensland, Australia.
Anaesth Crit Care Pain Med. 2021 Dec;40(6):100947. doi: 10.1016/j.accpm.2021.100947. Epub 2021 Sep 14.
Our understanding of chronic inflammation in obesity is evolving. Suggested mechanisms include hypoxia of adipose tissue and a subsequent increase in circulating cytokines. It is now known that adipose tissue, far from being an inert tissue, produces and secretes multiple peptides that influence inflammation and metabolism, including substrates of the renin-angiotensin-aldosterone system (RAAS). RAAS blocking antihypertensive medication and cholesterol-lowering agents are now being evaluated for their metabolic and inflammation-modulating effects. Surgery also has pro-inflammatory effects, which may be exacerbated in patients with obesity. This narrative review will summarise the recent literature surrounding obesity, metabolic syndrome, inflammation, and interplay with the RAAS, with evidence-based recommendations for the optimisation of patients with obesity, prior to surgery and anaesthesia.
我们对肥胖症慢性炎症的理解在不断发展。建议的机制包括脂肪组织缺氧和随后循环细胞因子的增加。现在已知，脂肪组织远非一种惰性组织，它会产生和分泌多种影响炎症和代谢的肽，包括肾素-血管紧张素-醛固酮系统（RAAS）的底物。RAAS 阻断降压药物和降胆固醇药物正在评估其代谢和炎症调节作用。手术也有促炎作用，在肥胖患者中可能会加剧。这篇叙述性综述将总结最近关于肥胖症、代谢综合征、炎症以及与 RAAS 相互作用的文献，为肥胖症患者在手术和麻醉前的优化提供基于证据的建议。
