炎症性肠病患者围手术期麻醉管理的研究进展
Research Progress on Perioperative Anesthetic Management in Patients with Inflammatory Bowel Disease
DOI: 10.12677/acm.2025.15102778, PDF,   
作者: 林栓同*:上海上实东滩疗养院麻醉科,上海;强玉婷:上海上实东滩疗养院护理部,上海
关键词: 炎症性肠病溃疡性结肠炎克罗恩病麻醉Inflammatory Bowel Disease Ulcerative Colitis Crohn’s Disease Anesthesia
摘要: 炎症性肠病(inflammatory bowel disease, IBD)是一类以慢性炎症和复发为特征的疾病,主要包括溃疡性结肠炎(ulcer colitis, UC)和克罗恩病(Crohn’s disease, CD)。随着全球IBD发病率持续上升,越来越多患者需接受外科手术,其围手术期管理复杂且充满挑战。本文系统梳理了IBD的流行病学、病理生理、诊断与治疗进展,并重点总结了围手术期麻醉管理的最新研究,旨在为麻醉医生提供一个全面、集中的知识框架,并为未来临床实践和多学科研究提供参考。
Abstract: Inflammatory bowel disease (IBD) is a group of conditions characterized by chronic inflammation and relapse, primarily including ulcerative colitis (UC) and Crohn’s disease (CD). With the global incidence of IBD continuing to rise, an increasing number of patients require surgical intervention, making perioperative management complex and challenging. This article systematically reviews the epidemiology, pathophysiology, diagnosis, and treatment advancements of IBD, with a particular focus on summarizing the latest research on perioperative anesthesia management. It aims to provide anesthesiologists with a comprehensive and consolidated knowledge framework, offering a reference for future clinical practice and multidisciplinary research.
文章引用:林栓同, 强玉婷. 炎症性肠病患者围手术期麻醉管理的研究进展[J]. 临床医学进展, 2025, 15(10): 461-468. https://doi.org/10.12677/acm.2025.15102778

参考文献

[1] Buie, M.J., Quan, J., Windsor, J.W., Coward, S., Hansen, T.M., King, J.A., et al. (2023) Global Hospitalization Trends for Crohn’s Disease and Ulcerative Colitis in the 21st Century: A Systematic Review with Temporal Analyses. Clinical Gastroenterology and Hepatology, 21, 2211-2221. [Google Scholar] [CrossRef] [PubMed]
[2] Coward, S., Clement, F., Benchimol, E.I., Bernstein, C.N., Avina-Zubieta, J.A., Bitton, A., et al. (2019) Past and Future Burden of Inflammatory Bowel Diseases Based on Modeling of Population-Based Data. Gastroenterology, 156, 1345-1353.e4. [Google Scholar] [CrossRef] [PubMed]
[3] Jones, G., Lyons, M., Plevris, N., Jenkinson, P.W., Bisset, C., Burgess, C., et al. (2019) IBD Prevalence in Lothian, Scotland, Derived by Capture-Recapture Methodology. Gut, 68, 1953-1960. [Google Scholar] [CrossRef] [PubMed]
[4] Kotze, P.G., Underwood, F.E., Damião, A.O.M.C., Ferraz, J.G.P., Saad-Hossne, R., Toro, M., et al. (2020) Progression of Inflammatory Bowel Diseases Throughout Latin America and the Caribbean: A Systematic Review. Clinical Gastroenterology and Hepatology, 18, 304-312. [Google Scholar] [CrossRef] [PubMed]
[5] Aniwan, S., Harmsen, W.S., Tremaine, W.J. and Loftus, E.V. (2019) Incidence of Inflammatory Bowel Disease by Race and Ethnicity in a Population-Based Inception Cohort from 1970 through 2010. Therapeutic Advances in Gastroenterology, 12, 1-8. [Google Scholar] [CrossRef] [PubMed]
[6] Ng, S.C., Kaplan, G.G., Tang, W., Banerjee, R., Adigopula, B., Underwood, F.E., et al. (2019) Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific. American Journal of Gastroenterology, 114, 107-115. [Google Scholar] [CrossRef] [PubMed]
[7] Okabayashi, S., Kobayashi, T. and Hibi, T. (2020) Inflammatory Bowel Disease in Japan-Is It Similar to or Different from Westerns? Journal of the Anus, Rectum and Colon, 4, 1-13. [Google Scholar] [CrossRef] [PubMed]
[8] Shah, S.C., Khalili, H., Chen, C., Ahn, H.S., Ng, S.C., Burisch, J., et al. (2019) Sex‐Based Differences in the Incidence of Inflammatory Bowel Diseases—Pooled Analysis of Population‐Based Studies from the Asia‐Pacific Region. Alimentary Pharmacology & Therapeutics, 49, 904-911. [Google Scholar] [CrossRef] [PubMed]
[9] Olfatifar, M., Zali, M.R., Pourhoseingholi, M.A., Balaii, H., Ghavami, S.B., Ivanchuk, M., et al. (2021) The Emerging Epidemic of Inflammatory Bowel Disease in Asia and Iran by 2035: A Modeling Study. BMC Gastroenterology, 21, Article No. 204. [Google Scholar] [CrossRef] [PubMed]
[10] 刘沙, 夏毅, 季峰. 靶向巨噬细胞的纳米粒在炎症性肠病诊治中的应用进展[J]. 浙江大学学报(医学版), 2023, 52(6): 785-794.
[11] Guan, Q. (2019) A Comprehensive Review and Update on the Pathogenesis of Inflammatory Bowel Disease. Journal of Immunology Research, 2019, Article ID: 7247238. [Google Scholar] [CrossRef] [PubMed]
[12] Sun, Y., Yuan, S., Chen, X., Sun, J., Kalla, R., Yu, L., et al. (2023) The Contribution of Genetic Risk and Lifestyle Factors in the Development of Adult-Onset Inflammatory Bowel Disease: A Prospective Cohort Study. American Journal of Gastroenterology, 118, 511-522. [Google Scholar] [CrossRef] [PubMed]
[13] 杨熙玥, 叶菜英, 朱蕾. NOD2介导的信号通路及其与自身炎症性疾病关系以及抑制剂研究进展[J]. 药学学报, 2023, 58(4): 899-908.
[14] 曾臻, 马春香, 张虎. 炎症性肠病的易感基因研究进展[J]. 中华炎性肠病杂志, 2019, 3(1): 30-34.
[15] Chen, J., Xu, F., Ruan, X., Sun, J., Zhang, Y., Zhang, H., et al. (2023) Therapeutic Targets for Inflammatory Bowel Disease: Proteome-Wide Mendelian Randomization and Colocalization Analyses. eBioMedicine, 89, Article ID: 104494. [Google Scholar] [CrossRef] [PubMed]
[16] Liu, Z., Liu, R., Gao, H., Jung, S., Gao, X., Sun, R., et al. (2023) Genetic Architecture of the Inflammatory Bowel Diseases across East Asian and European Ancestries. Nature Genetics, 55, 796-806. [Google Scholar] [CrossRef] [PubMed]
[17] Saez, A., Gomez-Bris, R., Herrero-Fernandez, B., Mingorance, C., Rius, C. and Gonzalez-Granado, J.M. (2021) Innate Lymphoid Cells in Intestinal Homeostasis and Inflammatory Bowel Disease. International Journal of Molecular Sciences, 22, Article 7618. [Google Scholar] [CrossRef] [PubMed]
[18] Zhou, W. and Sonnenberg, G.F. (2020) Activation and Suppression of Group 3 Innate Lymphoid Cells in the Gut. Trends in Immunology, 41, 721-733. [Google Scholar] [CrossRef] [PubMed]
[19] Tarris, G., de Rougemont, A., Charkaoui, M., Michiels, C., Martin, L. and Belliot, G. (2021) Enteric Viruses and Inflammatory Bowel Disease. Viruses, 13, Article 104. [Google Scholar] [CrossRef] [PubMed]
[20] Ma, H., Hu, T., Tao, W., Tong, J., Han, Z., Herndler-Brandstetter, D., et al. (2023) A lncRNA from an Inflammatory Bowel Disease Risk Locus Maintains Intestinal Host-Commensal Homeostasis. Cell Research, 33, 372-388. [Google Scholar] [CrossRef] [PubMed]
[21] Tao, H., Yu, Z., Dong, Y., Liu, L., Peng, L. and Chen, X. (2023) Lipids, Lipid-Lowering Agents, and Inflammatory Bowel Disease: A Mendelian Randomization Study. Frontiers in Immunology, 14, Article 1160312. [Google Scholar] [CrossRef] [PubMed]
[22] Wang, Y., Wang, M., Chen, J., Li, Y., Kuang, Z., Dende, C., et al. (2023) The Gut Microbiota Reprograms Intestinal Lipid Metabolism through Long Noncoding RNA SNHG9. Science, 381, 851-857. [Google Scholar] [CrossRef] [PubMed]
[23] Scalia, F., Carini, F., David, S., Giammanco, M., Mazzola, M., Rappa, F., et al. (2023) Inflammatory Bowel Diseases: An Updated Overview on the Heat Shock Protein Involvement. International Journal of Molecular Sciences, 24, Article 12129. [Google Scholar] [CrossRef] [PubMed]
[24] 中华医学会消化病学分会炎症性肠病学组, 中国炎症性肠病诊疗质量控制评估中心. 中国溃疡性结肠炎诊治指南(2023年∙西安) [J]. 中华炎性肠病杂志(中英文), 2024, 8(1): 33-58.
[25] 中华医学会消化病学分会炎症性肠病学组, 中国炎症性肠病诊疗质量控制评估中心. 中国克罗恩病诊治指南(2023年∙广州) [J]. 中华炎性肠病杂志(中英文), 2024, 8(1): 2-32.
[26] Doumas, S.A., Tsironis, C., Bolaji, A., Garantziotis, P. and Frangou, E. (2023) Glomerulonephritis and Inflammatory Bowel Disease: A Tale of Gut-Kidney Axis Dysfunction. Autoimmunity Reviews, 22, Article ID: 103327. [Google Scholar] [CrossRef] [PubMed]
[27] Mark-Christensen, A., Erichsen, R., Veres, K., Laurberg, S. and Sørensen, H.T. (2019) Extracolonic Cancer Risk after Total Colectomy for Inflammatory Bowel Disease: A Population-Based Cohort Study. Journal of Crohns and Colitis, 14, 630-635. [Google Scholar] [CrossRef] [PubMed]
[28] Mark-Christensen, A., Jølving, L.R., Anru, P.L., Murray, J.A., Nielsen, R.G., Qvist, N., et al. (2023) A Population-Based Nationwide Study on Total Colectomy for Ulcerative Colitis and Risk of Ten Prevalent Inflammatory or Autoimmune Diseases. Scandinavian Journal of Gastroenterology, 58, 1398-1404. [Google Scholar] [CrossRef] [PubMed]
[29] Gordon, H., Biancone, L., Fiorino, G., Katsanos, K.H., Kopylov, U., Al Sulais, E., et al. (2022) ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. Journal of Crohns and Colitis, 17, 827-854. [Google Scholar] [CrossRef] [PubMed]
[30] Luo, H., Cao, G., Luo, C., Tan, D., Vong, C.T., Xu, Y., et al. (2022) Emerging Pharmacotherapy for Inflammatory Bowel Diseases. Pharmacological Research, 178, Article ID: 106146. [Google Scholar] [CrossRef] [PubMed]
[31] Xu, G., Liu, T., Jiang, Y., Xu, Y., Zheng, T. and Li, X. (2024) Heterogeneity in Psychological Adaptation Patterns and Its Predictive Factors among Patients with Inflammatory Bowel Disease: A Latent Profile Analysis. Psychology Research and Behavior Management, 17, 219-235. [Google Scholar] [CrossRef] [PubMed]
[32] Bernstein, C.N., Nugent, Z. and Singh, H. (2021) Persistently High Rate of Venous Thromboembolic Disease in Inflammatory Bowel Disease: A Population-Based Study. American Journal of Gastroenterology, 116, 1476-1484. [Google Scholar] [CrossRef] [PubMed]
[33] Singh, S., Allegretti, J.R., Siddique, S.M. and Terdiman, J.P. (2020) AGA Technical Review on the Management of Moderate to Severe Ulcerative Colitis. Gastroenterology, 158, 1465-1496.e17. [Google Scholar] [CrossRef] [PubMed]
[34] Lin, C., Lin, H., Chen, H., Chen, N., Shih, I., Hung, J., et al. (2022) Perioperative Optimization of Crohn’s Disease. Annals of Gastroenterological Surgery, 7, 10-26. [Google Scholar] [CrossRef] [PubMed]
[35] Kotze, P.G. (2022) The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases. Clinics in Colon and Rectal Surgery, 35, 3-4. [Google Scholar] [CrossRef] [PubMed]
[36] Scow, J.S. (2024) Modern Surgery for Crohn’s Disease: When to Divert, Impact of Biologics on Infectious Complications, and Surgical Techniques to Decrease Post-Operative Recurrence of Crohn’s Disease. Surgery Open Science, 19, 20-23. [Google Scholar] [CrossRef] [PubMed]
[37] Bak, M.T.J., Ruiterkamp, M.F.E., van Ruler, O., Campmans-Kuijpers, M.J.E., Bongers, B.C., van Meeteren, N.L.U., et al. (2022) Prehabilitation Prior to Intestinal Resection in Crohn’s Disease Patients: An Opinion Review. World Journal of Gastroenterology, 28, 2403-2416. [Google Scholar] [CrossRef] [PubMed]
[38] Chen, Y., Lu, Y., Xiang, X., Fu, L., Liu, Y., Li, C., et al. (2023) Efficacy and Safety Analysis of Midazolam Combined with Dezocine Sedation and Analgesia Colonoscopy in Patients with Inflammatory Bowel Disease: A Prospective Single-Center Open Study. Frontiers in Pharmacology, 14, Article 1150045. [Google Scholar] [CrossRef] [PubMed]
[39] Zhang, T., Xu, Y., Yao, Y., Jin, L., Liu, H., Zhou, Y., et al. (2021) Randomized Controlled Trial: Perioperative Dexamethasone Reduces Excessive Postoperative Inflammatory Response and Ileus after Surgery for Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 27, 1756-1765. [Google Scholar] [CrossRef] [PubMed]
[40] Tsuboi, S., Kubota, K., Mihara, T., Taguri, M., Inagawa, G. and Goto, T. (2022) Predictive Factors of Postoperative Fentanyl Consumption in Patients with Inflammatory Bowel Disease: A Retrospective Cohort Study. BMC Anesthesiology, 22, Article No. 70. [Google Scholar] [CrossRef] [PubMed]
[41] Freundlich, A., Gozal, E., Grisaru-Granovsky, S., Grass, A., Bar-Gil Shitrit, A. and Ioscovich, A. (2021) Peripartum Anesthetic Management of Patients with Inflammatory Bowel Disease, a Retrospective Case-Control Study. 60, 70-77. [Google Scholar] [CrossRef] [PubMed]