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Perioperative Intestinal Injury: Etiology, Mechanism, and Prevention

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Severe Trauma and Sepsis

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Abstract

Perioperative organ injury is a severe and commonly encountered problem in surgical practice and has been drawing great attention from physicians and researchers. Under the philosophy of precision medicine and fast-track surgery, anesthesiologists have direct influence on patients’ long-term outcomes by protecting important organs during perioperative period. This will reflect the evolvement of anesthesiology to perioperative medicine. There had been widespread concern over the mechanism and prevention of perioperative heart, brain, lung, and kidney injuries. Whereas the intestine is a luminal organ, research interests were often put to its digestive, absorbing, and excretory functions. In fact, intestines have much more functions than that mentioned above; intestine barrier has complex components, which can be easily affected by internal or external factors such as ischemia, hypoxia, infection, stress, or prolonged administration of antibiotics or immunosuppressants. Among these factors, intestinal ischemia is the most common cause of perioperative intestinal injury; this process not only occurs during the hypoperfusion stage but more importantly after blood supply was restored, namely, ischemia/reperfusion injury. The further intestinal injury caused by reperfusion and the consequent extraintestinal organ injuries were called second hit. The impaired intestinal mucosal barrier and subsequent translocation of intestinal bacteria and endotoxin can result in systemic inflammatory reaction syndrome. Here, we review the progress in the study of the mechanism, prevention, and treatment of perioperative intestinal injury (especially intestinal I/R injury), hoping to provide some useful information for clinical practice.

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Authors and Affiliations

  1. Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China

    Xiao-Dong Chen & Ke-Xuan Liu

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  1. Xiao-Dong Chen
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  2. Ke-Xuan Liu
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  1. Wound Healing and Cell Biology Lab, First Affiliated Hospital, Chinese PLA General Hospital, Beijing, China

    Xiaobing Fu

  2. State Key Laboratory of Trauma, Burns, and Combined Injury, Daping Hospital, Third Military Medical University, Chong Qing, China

    Liangming Liu

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Chen, XD., Liu, KX. (2019). Perioperative Intestinal Injury: Etiology, Mechanism, and Prevention. In: Fu, X., Liu, L. (eds) Severe Trauma and Sepsis. Springer, Singapore. https://doi.org/10.1007/978-981-13-3353-8_3

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