Pathogenesis and clinical and economic consequences of postoperative ileus.
Pathogenesis and clinical and economic consequences of postoperative ileus.
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DOI：
10.2147/ceg.s4243
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发表时间：
2010
影响因子：
2.4
通讯作者：
Senagore AJ
中科院分区：
文献类型：
--
作者：
Senagore AJ
术后肠梗阻（POI）经常发生在接受腹部大手术的患者中;直到最近，人们才重新关注POI的发病机制、病因、临床表现以及临床和经济后果。这种兴趣已经被潜在的获得用于POI管理的新药物选择所激发。POI具有复杂和多模式的病理生理学，包括神经原性、炎症、激素和药理学成分。临床表现在临床上是明显的，包括腹胀、疼痛、恶心、呕吐和不能排便或不能耐受固体饮食。长期肠梗阻定义为腹部大手术后这些症状持续4天以上;然而，目标应该是减少术后立即出现这些症状的发生率。显然，手术压力的大小和阿片类镇痛剂的使用是POI的主要原因。POI的未被重视的后遗症包括不良手术伤口愈合率增加、截肢率降低、肺不张、肺炎、尿路感染和深静脉血栓形成。这些并发症的次要影响包括住院时间延长、资源使用和医疗费用增加。POI很常见，其影响被低估。添加alvimopan作为第一类μ-阿片类抑制剂，在降低POI的发生率和影响方面表现出一致的获益，同时缩短住院时间。POI是腹部大手术的常见且未被充分认识的并发症，临床医生应了解可成功降低该术后并发症发生率的临床护理选择，包括新型药物。
Postoperative ileus (POI) occurs frequently in patients undergoing major abdominal surgery; and only recently has there been renewed interest in understanding the pathogenesis, etiology, clinical manifestations, and clinical and economic consequences related to POI. This interest has been spurred by the potential access to novel pharmaceutical options for the management of POI. POI has a complex and multimodal pathophysiology including neurogenic, inflammatory, hormonal, and pharmacologic components. The clinical manifestations are clinically obvious and include abdominal distention, pain, nausea, vomiting, and inability to pass stools or tolerate a solid diet. Prolonged ileus has been defined as persistence of these symptoms for more than 4 days after major abdominal surgery; however the goal should be to reduce the incidence of these symptoms immediately after surgery. Clearly, the magnitude of the surgical stress and usage of opioid analgesia are the predominant causes of POI. The unappreciated sequelae of POI include increased rates in adverse surgical wound healing, reduced ambulation, atelectasis, pneumonia, urinary infections, and deep vein thrombosis. The secondary impact of these complications includes increased hospital length of stay, resource use, and healthcare costs. POI is common and the impact is underestimated. The addition of alvimopan as the first in class μ-opioid inhibitor has demonstrated consistent benefit in reducing the incidence and impact of POI with reductions in length of hospital stay. POI is a common, and underappreciated complication of major abdominal surgery, and clinicians should be aware of the clinical care options, including novel pharmaceutical agents, that can successfully reduce the incidence of this postoperative complication.