手术应激后低蛋白血症启因及治疗的最新进展

Recent advances in the pathogenesis and treatment of hypoproteinemia after surgical stress

临床上在大手术后的创伤、应激状态下，机体会发生一系列复杂的病理生理变化，蛋白质的合成受到影响，导致负氮平衡。此外，炎性因子释放、毛细血管内皮细胞损伤，使微血管通透性增加，血管中的胶体白蛋白渗漏到血管外组织，血浆胶体渗透压降低，创面水肿，最终出现术后低蛋白血症。临床治疗除补充白蛋白外，应针对其发生机制，控制应激反应，降低炎性因子释放所造成的渗漏，才能从根本上解决这一问题。回顾近年来有关大手术后低蛋白血症的成因及治疗方法的相关研究，以期为临床术后治疗提供依据。

After major operation, a series of complicated pathological and physiological changes will occur during the trauma and stress state. The protein synthesis is affected, which results in negative nitrogen balance. In addition, the release of inflammatory factors can damage the capillary endothelial cells and increase the permeability of micrangium, induce vascular colloidal albumin leakage to the extravascular tissue, decrease plasma albumin, make wound edema, eventually lead to postoperative hypoproteinemia. Except for albumin supplement, it should be aimed at the mechanism to control the stress response and reduce the leakage caused by the release of inflammatory factors to solve this problem radically in clinical work. The reports about the causes and treatment of hypoproteinemia after major surgery were reviewed to provide evidence for clinical treatment.