【作者】 董小超；

【导师】 易定华；

【作者基本信息】 第四军医大学 ， 外科学， 2006， 硕士

【摘要】 消化道并发症是心脏手术后死亡率较高的并发症。与体外循环有关的消化系统严重并发症发生率为0.5％-3％，虽然发生率很低，但危害很大，一旦发生，死亡率可高达92％-94％。体外循环心脏直视手术后常见的消化道并发症，包括消化道溃疡，出血，穿孔，胰腺炎，胆囊炎，小肠坏死梗阻，肝坏死等。消化道出血因其体征明显多见报道。而消化道出血和穿孔的部位以多发性胃和十二指肠溃疡多见。多数学者认为，机体处于休克、脓毒血症等应激状态时，引起下丘脑功能失调，分泌大量促肾上腺皮质激素(ACTH)，其作用使胃液分泌增加，造成胃黏膜糜烂与溃疡。应激性溃疡(SU)是机体在应激状况下胃的粘膜组织出现一种以胃黏膜糜烂或浅表性溃疡为特征的急性胃黏膜病变，并导致急性上消化道出血。在应激状态下，由于儿茶酚胺类物质增多，使胃黏膜表面的上皮细胞因缺氧而坏死，中和酸的能力下降，中和返流H~+的能力也下降，而使H~+在组织内蓄积，pH下降，由于胃黏膜酸化，胃黏膜pH(pHi)下降，极易形成SU。由于缺血产生的酸中毒或胆汁返流均可破坏胃黏膜的保护作用。 血液在体外循环中和异物表面接触释放大量炎性物质。激活内皮细胞(EC)，使EC表面ICAM-1等表达上调。ICAM-1，在炎症的早期参与调节或影响NSAIDs诱导的中性粒细胞(PMN)在血管内皮上的粘附，在导致胃黏膜损伤中起着重要作用。肿瘤坏死因子(TNF)是内毒素以及各种侵袭性刺激引起活化的单核一巨噬细胞释放的细胞因子，其作用广泛。有人认为是一更多还原

【Abstract】 Gastrointestinal complication has a high mortality after cardiac surgery. The digestive complication caused by cardiopulmonary bypass has a rate about 0.5%-3%. The incidence seems very small, but when it happens the mortality may be as high as 92%-94%. There are several kinds of digestive complication after cardiac surgery with CPB, such as alimentary tract ulcer, hemorrhage, perforation, pancreatitis, cholecystitis, necrosis and obstruction of small intestine, hepatonecrosis and so on. Alimentary tract hemorrhage has been reported more than others because of its obvious signs. Alimentary tract hemorrhage and perforation often take place in stomach and duodenum that have already has multiple ulcers. Most scholars think that when human body in stringent state, such as shock, pyemia, it may cause hypothalamus’ functino disorder. Then there will be more adrenocorticotropic hormone secreted, and under the effect of ACTH, the secretion of gastric juice increased, that may lead to gastric mucosal erosion and ulcer. Stress ulcer(SU) is an acute gastric mucosal process which has an character of gastric mucosal erosion or exulceratio simplex. It can also induce acute upper gastrointestinal bleeding. In stress state, the leval of catecholamines更多还原