The Role of the Gut in Major Surgical Postoperative Morbidity

摘要: Gut mucosal hypoperfusion has been termed the motor of multiple organ failure. While a large proportion high-risk surgery proceeds unremarkably, insult to inflammatory system during perioperative periods regional may manifest themselves over subsequent few days, leading microvascular thrombi, dysfunction, and Several approaches have made prevent this, including systemic optimization cardiovascular specific targeting splanchnic circulation with monitoring techniques such as tonometry or metabolic markers hepatic function guide fluid drug therapies. It is believed that in patients methods are not likely suffice gut probable. If these can be identified preoperatively, then recently developed used prophylactically immunonutrition, passive active immunization, antimediator agents, nonspecific anti-inflammatory agents help minimize number progressing dysfunction Techniques us identify at-risk include in-depth assessment, possibly echocardiography noninvasive cardiac output monitor suprasternal adaptation ODM esophageal Doppler. The measurement baseline endotoxin immune status (EndoCAb) select those advance who most from hypoperfusion, thus allowing more rational use tonometry. Conventional risk scoring systems conjunction knowledge type undertaken whether shifts along less conventional discussed above enable therapy closer optimal.