加速康复外科理念在稳定肠道微生物群中的作用研究进展

人类的微生物群由各种细菌、古生菌、微真核生物和病毒组成,它们广泛分布于人体与外界相通的器官和组织中,其中大部分微生物寄居于人消化道内。那些处于胃肠道中的微生物群既参与了宿主宏量营养素(糖、脂肪、氨基酸)的代谢过程,也参与了部分微量营养素(维生素、铁、锌)的代谢过程。不仅如此,它们还在维持肠道生物屏障、抗击炎症、调节细胞坏死、启动免疫相关进程等方面起着重要作用。临床实践中的禁饮禁食、创伤以及手术应激等因素容易导致肠道微生物群紊乱、肠屏障功能损伤和肠黏膜通透性增加进而引发肠菌群移位、肠源性感染。随后全身炎症反应综合征和多器官功能衰竭接踵而来。如何更好地维护肠道微生物群稳定、保护肠道功能屏障成为医疗工作者所要面临的问题。加速康复外科是一套在围手术期采取各种有效的措施来减少手术应激及创伤、加速患者术后康复的外科模式,其已成为近几年来外科领域的研究热点。因其理念及一些相关措施,如:缩短术前禁饮食时间、不机械性灌肠、术后尽早恢复饮食等措施能更好地维护肠道微生物群稳定、保护肠道功能屏障、促进胃肠功能恢复,所以加速康复外科的实施为我们在围手术期更好地保护和利用胃肠道提供了途径。在此,本文就肠道微生物群组成及其参与营养物质代谢的功能、加速康复外科理念、加速康复外科与肠微生物群之间的联系进行综述。 

The role of enhanced recovery after surgery in preserving gut microbiota

The human microbiome is composed of a variety of bacteria, archaea, microeukaryotes and viruses. They are widely distributed in organs and tissues in which the human body is exposed to the outside world, and most of them live in the human digestive tract. The microbiota in gastrointestinal tract not only participated in the metabolic process of macro nutrient (sugar, fat and amino acids), but also participated in the metabolism process of some micronutrients (vitamins, iron and zinc). Not only that, they also play an important role in maintaining intestinal biological barriers, fighting inflammation, regulating cell necrosis, and initiating immune related processes. Such factors as prohibition of drinking, fasting, trauma, Surgical stress and other factors in clinical practice are likely to lead to intestinal microflora disturbance, intestinal barrier function damage and intestinal mucosal permeability increase, leading to intestinal flora shift and intestinal infection. Subsequent systemic inflammatory response syndrome and multiple organ failure followed. How to maintain the stability of intestinal microflora and protect intestinal function barrier has become a problem for medical workers. The enhanced recovery after surgery is a set of effective measures to reduce the surgical stress and trauma and accelerate the postoperative recovery of the patients during the perioperative period. Because of its concept and some relevant measures, such as shorten preoperative fasting time, non mechanical enema, early postoperative diet can better maintain the intestinal microflora stability, protect the intestinal function barrier, promote the recovery of gastrointestinal function. Therefore, the implementation of enhanced recovery after surgery provides a way for us to better protect and utilize the gastrointestinal tract during the perioperative period. Here, we reviewed the composition of intestinal microflora and its functions in nutrition metabolism, the concept of enhanced recovery after surgery, the relationship between enhanced recovery after surgery and intestinal microflora.