乌司他丁对手术创伤后肠屏障功能的影响

肠道是外科应激反应的中心器官之一。当外科应激反应过度或失调时，肠黏膜屏障的完整性首先遭到破坏，原先寄生于肠道内的微生物及其毒素经过通透性增高的肠黏膜进入血液循环，触发全身炎性反应(SIRS)和多器官系统衰竭(MOSF)，反过来又可加重肠黏膜坏死和细菌移位，形成恶性循环。腹部重大手术具有典型的外科应激反应。术后由于细胞因子和炎性介质等作用，可出现肠黏膜水肿、通透性增高，肠绒毛高度降低，肠系膜血管收缩，血流量减少，从而损伤肠黏膜的屏障功能。乌司他丁可能通过抗手术应激、减轻SIRS、改善免疫功能等作用，保护肠黏膜屏障功能。作者就乌司他丁对手术创伤应激后肠黏膜屏障功能的影响作一综述。

Influence of ulinastatin on intestinal barrier function after radical total gastrectomy

Intestinal tract is one of the target organ during surgical stress. When surgical stress becomes overwhelming , the integrity of intestinal mucosal barrier is destroyed. Microorganisms and toxin in the intestinal tract then enter blood circulation through the permeable intestinal mucosa, and trigger SIRS and MODS, This processes reversely aggravate intestinal mucosal necrosis and bacterial translocation, and lead to a vicious cycle. Radical total gastrectomy is a major surgical stress. After extensive abdominal surgery, cytokines and inflammatory mediators may cause intestinal mucosal edema, increased intestinal permeability, intestinal villus height reduced, shrinkage of mesenteric blood vessel, reduced blood flow, and intestinal barrier functional deterioration. Whereas ulinastatin can protect intestinal barrier function by reducing surgical stress,alleviating SIRS and improving immunity etc. This article reviewed the investigations of ulinastatin influencing the recovesy of intestinal barrier function after surgical stress.