心脏手术的炎性反应及治疗策略

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心脏手术的炎性反应及治疗策略
陈仁伟
中图分类号 : R654. 2 ( 综述 ) , 高纪平 ( 审校 ) 文章编号 : 1006 2084 ( 2010 ) 23 362长沙 410007 ) 文献标识码 : A
摘要 : 炎性反应的普遍激活在任何一种手术方式中 都能观察 到 , 它是机 体对外科 创伤的普 遍反 应 。 心脏体外循环手术可以通过不同的方式激活炎 性反应 。 围术 期应激反 应增加表 明心脏和 肺部 并发症的风险 , 其临床后果被称为 ! 全身炎性反应综合征 ∀, 可能 造成危及生命 的器官功能障 碍 。 为 了解这种复杂的炎性反应作用 , 以及发现减轻器官功能障碍后果的策略 。 现就 目前关于炎性 反应各 种介质 、 手术应激的作用 、 器官损伤的发病机制以及限制和克服这种反应的策略予以综述 。 关键词 : 心脏手术 ; 体外循环 ; 炎性反应 Infla mma tory Response to Cardia c Surgery and Therapeutic Strategies C H EN R en w e i , GAO J i p ing. (D epart m ent of Ca rdioth orac ic S urgery, H unan Ch ild ren sH os p ita l, Chang s ha 410007 , Ch ina ) Abstract : A general activation of in flamm atory respon se can b e ob served du ring any operative proce du re, as physiological respon se to surg ical st ress . Card iac operations under card iopu l m onary bypass support m ay act ivate the in flamm atory response through dist inctly d ifferent m echan is ms . Perioperat ive stress response rep resen ts th e increased risk of myocardial and pu l m on ary com pl icat ion s . Th e clin ical consequences of stress response ter m ed s 'ystem ic in flamm atory response syndrom e ' m ay resu lt in life threaten ing organ dysfunction . To unders tand th is com plex in terp lay of in flamm atory respon se and to develop the strategies to res trict the resu lt ant organ dysfun ct ion, the iteratures of variou s m ed iators for su ch in flamm atory response, th e ro le of su rgical stress , the pathogenesis of organ dam age , and strategies to overcom e th is response are review ed . K ey words : C ard iac surgery ; C ardiopu l m onary bypass ; I n flamm at ion
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