摘要
全球每年大约开展3.13亿次外科手术,至少有4200万人于术后30 d内死亡,术后并发症已然成为第三大死亡原因。研究表明,围手术期保护迷走神经(VN)功能能够降低术后并发症的发生率和死亡率,促进患者术后康复。VN广泛地散布于各组织器官中,构成一个庞大复杂的神经-内分泌-免疫网络,在调整呼吸节律、保护心血管、参与免疫应答、促进消化吸收、调节机体代谢等方面发挥着重要作用。然而,过度应激、机械损伤等因素常造成手术患者VN的功能损伤。VN功能紊乱又是介导多种术后并发症的潜在机制。加速康复外科(ERAS)率先认识到VN功能的重要性,并采取了一系列围手术期管理措施保护VN功能。文章就VN对围手术期机体稳态的调控和围手术期创伤应激对VN功能的损伤以及加速康复外科对VN功能的保护作一综述,以期让更多外科医师了解到围手术期保护VN功能的重要性,进一步优化ERAS临床管理路径。
Approximately 313 million surgical operations were performed globally every year,and at least 42 million people died within 30 days after surgery.Postoperative complications have become the third leading cause of death.Recent studies have shown that protecting the function of vagus nerve(VN)during the perioperative period can reduce the incidence of postoperative complications and mortality,and promote postoperative recovery.VN is widely distributed in various tissues and organs,forming a huge and complex nerve-endocrine-immune network.It plays a significant role in regulating respiratory rhythm,protecting cardiovascular system,participating in immune response,promoting digestion and absorption,and regulating metabolism.However,excessive stress,mechanical injury and other factors often lead to the functional damage of VN.The decrease of VN activity is the potential mechanism for many postoperative complications.Enhanced recovery after surgery(ERAS)was the first to recognize the importance of the function VN and has adopted a series of perioperative management measures to protect VN function.Therefore,this review summarizes what measures ERAS has taken to protect VN,and initially discusses the mechanisms between protecting the function of VN with reduce postoperative complications and promote organ function recovery.We expect that more surgeons will understand the importance of protecting the function of VN during the perioperative period,and further optimize the clinical management pathways of ERAS.
作者
沈丹丽
成汇(综述)
王刚
江志伟(审校)
SHEN Dan-li;CHENG Hui(reviewing);WANG Gang;JIANG Zhi-wei(checking)(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,210029,Jiangsu,China)
出处
《医学研究生学报》
CAS
北大核心
2021年第2期200-204,共5页
Journal of Medical Postgraduates
基金
江苏省中医药管理局重点项目(ZD201903)
江苏省研究生科研创新计划项目(SJCX20_0603)。
关键词
迷走神经
加速康复外科
副交感神经
vagus nerve
enhanced recovery after surgery
parasympathetic
