延迟性术后肠麻痹的概念及防治策略  

Concept and prevention of prolonged postoperative ileus

作　　者：江志伟 王刚 JIANG Zhiwei;WANG Gang(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院,江苏省中医院普通外科,江苏南京210029

出　　处：《山东大学学报（医学版）》2020年第5期1-5,45,共6页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81500417);江苏省中医药局科技项目(JD201807)。

摘　　要：术后肠麻痹(POI)是外科手术后由于非机械原因导致的胃肠道运动功能受到暂时性抑制,造成无法经口摄入的临床现象,其发病机制涉及手术创伤、麻醉药物、交感神经系统亢进和肠道炎症反应等多个因素。从病理生理学角度,POI可分为早期的神经源性阶段和后期的炎症阶段;从临床角度,POI可分为生理性POI和延迟性POI(PPOI)。PPOI定义的规范有利于统计PPOI的准确发病率,并分析其风险因素,从而提出预防和治疗措施。加速康复外科理念和微创技术显著降低了PPOI发生率,是预防和治疗PPOI较理想的方案。虽然,在PPOI的预防和治疗方面取得了一些效果,PPOI仍然是一个具有挑战性的临床问题。Postoperative ileus, which develops after abdominal surgical procedures, is an iatrogenic disorder characterized by a transient inhibition of gastrointestinal motility. Its mechanism involves surgical trauma, anesthetics, sympathetic nervous system hyperreaction, intestinal inflammatory response, and so on. From the pathophysiological perspective, POI can be classified into early neurogenic stage and later inflammatory stage;from the clinical perspective, it can be classified into physiological POI and prolonged POI(PPOI). The normalized definition of PPOI is helpful to collect the accurate incidence, analyze its risk factors and propose preventive and therapeutic measures. The concept of accelerated recovery after surgery(ERAS) and minimally invasive surgery have significantly reduced the incidence of PPOI. Although achievements have been made in the prevention and treatment, PPOI remains a challenging clinical problem.

关 键 词：术后肠麻痹 延迟性术后肠麻痹 病理生理学 加速康复外科 

分 类 号：R619[医药卫生—外科学]