免疫功能障碍与围手术期感染

Immune dysfunction and perioperative infection

原发疾病与手术均可能导致机体免疫功能受到多重打击而发生障碍,使围手术期感染发生率及病死率增高。高龄、营养不良、肥胖、糖尿病、肿瘤等基础状态及吸烟、嗜酒等不良嗜好,均可影响机体的非特异性免疫和细胞介导免疫反应、抗体介导的体液免疫,导致机体免疫功能障碍,增加感染风险。而临床与基础研究显示,手术应激损伤引起血流动力学、代谢、神经-内分泌等方面的复杂病理生理变化,在机体释放大量炎性介质发生全身炎性反应综合征的同时,引发代偿性抗炎反应综合征,导致机体发生一过性创伤或手术后免疫功能障碍而继发围手术期感染。原发疾病、病人基础状况及手术创伤程度互相影响。因此,须应用综合治疗手段才能降低围手术期发生感染的风险。

The primary disease and surgery may lead to multiple strikes on immune function, which contributes to higher perioperative infection rate, patient morbidity and mortality. Nonspecific immune response, cell-mediated immune response and antibody mediated humoral immune response could be affected by the basic health status such as aging, malnutrition, obesity, diabetes, cancer and the bad habits for example smoking and alcohol, leading to immune dysfunction, which increases the risk of perioperative infection. The clinical and basic researches showed that a serial complicated pathophysiologic changes on hemodynamics, metabolism, and nerve-endocrine system is caused by the surgery stress damage. It release a large numbers of pro-inflammatory mediators resulting in systemic inflammatory response syndrome, and initiate compensatory anti-inflammatory response syndrome at the same time, which leads to temporary innnune dysfunction after trauma or surgery, triggering secondary perioperative infections. To reduce perioperative infection relies on combined interventions due to the interacts among the primary disease, basic condition and surgical trauma.