Kehlet H
Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.
Br J Anaesth. 1997 May;78(5):606-17. doi: 10.1093/bja/78.5.606.
Major surgery is still associated with undesirable sequelae such as pain, cardiopulmonary, infective and thromboembolic complications, cerebral dysfunction, nausea and gastrointestinal paralysis, fatigue and prolonged convalescence. The key pathogenic factor in postoperative morbidity, excluding failures of surgical and anaesthetic technique, is the surgical stress response with subsequent increased demands on organ function. These changes in organ function are thought to be mediated by trauma-induced endocrine metabolic changes and activation of several biological cascade systems (cytokines, complement, arachidonic acid metabolites, nitric oxide, free oxygen radicals, etc). To understand postoperative morbidity it is therefore necessary to understand the pathophysiological role of the various components of the surgical stress response and to determine if modification of such responses may improve surgical outcome. While no single technique or drug regimen has been shown to eliminate postoperative morbidity and mortality, multimodal interventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperative morbidity and overall costs.
大手术仍会伴有不良后遗症，如疼痛、心肺、感染及血栓栓塞并发症、脑功能障碍、恶心和胃肠麻痹、疲劳以及恢复期延长。术后发病的关键致病因素，不包括手术和麻醉技术失误，是手术应激反应以及随后对器官功能需求的增加。这些器官功能的变化被认为是由创伤诱导的内分泌代谢变化和几种生物级联系统（细胞因子、补体、花生四烯酸代谢产物、一氧化氮、游离氧自由基等）的激活所介导的。因此，为了理解术后发病情况，有必要了解手术应激反应各个组成部分的病理生理作用，并确定对这种反应的调节是否可以改善手术结果。虽然没有单一的技术或药物方案已被证明能消除术后发病和死亡，但多模式干预可能会大幅减少手术损伤的不良后遗症，提高恢复情况，降低术后发病率和总体成本。
