Poredos Peter, Komadina Radko
Department of Anaesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
The Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia.
Cells. 2025 Sep 1;14(17):1362. doi: 10.3390/cells14171362.
Surgery and anesthesia induce a stress response that provokes increased sympathetic stimulation, secretion of cortisol, hypercoagulability, and systemic inflammatory response. All these homeostatic deteriorations, especially systemic inflammation, represent a risk for organ damage. Perioperative cardiac complications have an increasing impact on morbidity and mortality, not only in cardiovascular but also in non-cardiac surgery. Surgical procedures represent a potential trigger for systemic inflammation that causes secretion of proinflammatory cytokines, activation of neutrophils, and tissue damage. Also, increased levels of preoperative inflammatory markers predict perioperative cardiovascular events. Systemic inflammatory biomarkers increase during the first days after surgical procedures and decline within a few weeks. Besides contemporary traditional biomarkers (CRP, BNP), newer biomarkers, such as galectin-3, TNF-α, and various MiRNAs, can predict inflammatory response and related cardiac injury. Determination of inflammatory markers in the perioperative period could help identify patients at risk for cardiovascular events. The reduction in perioperative inflammatory response may improve surgical outcomes. Prevention and treatment of systemic inflammation can be achieved by optimization of surgical procedures, anesthetic regimen, and pharmacological agents, especially interleukin inhibitors. Determination of inflammatory biomarkers, along with prevention and treatment of inflammation, can improve perioperative cardiac risk reduction strategies.
手术和麻醉会引发应激反应，导致交感神经刺激增加、皮质醇分泌、血液高凝状态及全身炎症反应。所有这些内稳态恶化情况，尤其是全身炎症，均代表着器官损伤的风险。围手术期心脏并发症对发病率和死亡率的影响日益增加，不仅在心血管手术中如此，在非心脏手术中亦是如此。外科手术是全身炎症的潜在触发因素，可导致促炎细胞因子分泌、中性粒细胞活化及组织损伤。此外，术前炎症标志物水平升高可预测围手术期心血管事件。全身炎症生物标志物在外科手术后的头几天会升高，并在几周内下降。除了当代传统生物标志物（CRP、BNP）外，诸如半乳糖凝集素-3、肿瘤坏死因子-α和各种微小RNA等新型生物标志物也可预测炎症反应及相关心脏损伤。围手术期炎症标志物的测定有助于识别有心血管事件风险的患者。围手术期炎症反应的减轻可能会改善手术结局。通过优化手术操作、麻醉方案和药物制剂，尤其是白细胞介素抑制剂，可实现全身炎症的预防和治疗。炎症生物标志物的测定以及炎症的预防和治疗可改善围手术期降低心脏风险的策略。
