Tønnesen H, Petersen K R, Højgaard L, Stokholm K H, Nielsen H J, Knigge U P, Kehlet H
Kirurgisk gastroenterologisk afdeling, Hvidovre Hospital, København.
Ugeskr Laeger. 1994 Jan 17;156(3):287-90.
Retrospective studies suggest increased postoperative morbidity among alcohol misusers. We have prospectively studied the risk associated with alcohol intake among patients undergoing surgery. We investigated 15 persons who required colorectal surgery and who were drinking at least five Danish drinks per day. These patients were matched for sex, nutrition, age, weight, cardio-pulmonary disease, diagnosis anesthesia, and surgery to 15 control persons who were consuming no more than two drinks daily. None of the patients showed signs of liver disease. The alcohol group developed more postoperative complications than controls (67 vs 20%, p < 0.05) and hospital stay was prolonged (20 vs 12 days, p < 0.05). Preoperatively, alcohol misusers had reduced left ventricular ejection fraction (54 vs 68%, p < 0.01). Delayed-type hypersensitivity responses were reduced in the alcohol group before (53 mm2 vs 78, p < 0.05) and after (18 mm2 vs 55, p < 0.01) surgery. Alcohol misusers had significantly longer bleeding times. Surgical stress responses, as assessed by changes in plasma cortisol and catecholamines, were higher among alcohol misusers (p < 0.05). Postoperative morbidity was increased in alcohol misusers without signs of liver damage. The mechanisms may include subclinical cardiac insufficiency, immunosuppression, and decreased haemostatic function. Preoperative alcohol consumption may be a more important risk factor for postoperative morbidity than previously thought.
回顾性研究表明，酗酒者术后发病率增加。我们对接受手术患者的酒精摄入相关风险进行了前瞻性研究。我们调查了15名需要进行结直肠手术且每天至少饮用五杯丹麦酒的患者。这些患者在性别、营养状况、年龄、体重、心肺疾病、诊断麻醉和手术方面与15名每天饮酒不超过两杯的对照者进行匹配。所有患者均无肝病迹象。饮酒组术后并发症比对照组更多（67% 对20%，p < 0.05），住院时间延长（20天对12天，p < 0.05）。术前，酗酒者左心室射血分数降低（54% 对68%，p < 0.01）。饮酒组术前（53平方毫米对78，p < 0.05）和术后（18平方毫米对55，p < 0.01）迟发型超敏反应均降低。酗酒者出血时间明显更长。通过血浆皮质醇和儿茶酚胺变化评估的手术应激反应在酗酒者中更高（p < 0.05）。无肝损伤迹象的酗酒者术后发病率增加。其机制可能包括亚临床心脏功能不全、免疫抑制和止血功能下降。术前饮酒可能是比之前认为的更重要的术后发病风险因素。
