The metabolic and endocrine response to trauma

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI:10.1016/j.mpaic.2026.02.017

Christina Dunn, Andrew McGuire

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引用次数: 0

Abstract

Major injury provokes an immediate neuroendocrine, inflammatory and metabolic response. Early sympathetic activation, cortisol release and renin–angiotensin–aldosterone activity preserve perfusion but drive tachycardia, vasoconstriction, hyperglycaemia and early catabolism. Endothelial injury, acidosis, hypothermia and low ionized calcium contribute to trauma-induced coagulopathy and the lethal diamond. These processes inform modern resuscitation, which prioritizes rapid haemorrhage control, balanced resuscitation, permissive hypotension when appropriate and prevention of secondary physiological insults.

Whole blood and viscoelastic testing increasingly support targeted haemostatic therapy. Anaesthetic management must anticipate severe cardiovascular instability and avoid worsening shock physiology. Beyond the acute phase, sustained hypermetabolism, insulin resistance and protein breakdown hinder recovery, with burns representing the most extreme form. Early enteral nutrition, safe glucose targets and identification of longer-term endocrine disturbances are central to limiting muscle loss and supporting rehabilitation.

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代谢和内分泌对创伤的反应

严重的损伤会立即引起神经内分泌、炎症和代谢反应。早期交感神经激活、皮质醇释放和肾素-血管紧张素-醛固酮活性维持灌注，但导致心动过速、血管收缩、高血糖和早期分解代谢。内皮损伤、酸中毒、体温过低和低钙离子导致创伤性凝血功能障碍和致命的钻石。这些过程为现代复苏提供了信息，它优先考虑快速出血控制、平衡复苏、适当时允许性低血压和预防继发性生理损伤。全血和粘弹性试验越来越支持靶向止血治疗。麻醉管理必须预见到严重的心血管不稳定，避免恶化休克生理。在急性期之后，持续的高代谢、胰岛素抵抗和蛋白质分解会阻碍恢复，烧伤是最极端的形式。早期肠内营养、安全的葡萄糖目标和识别长期内分泌紊乱是限制肌肉损失和支持康复的核心。

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来源期刊

Anaesthesia and Intensive Care Medicine ANESTHESIOLOGY-

CiteScore

0.50

自引率

0.00%

发文量

152

期刊介绍： Anaesthesia and Intensive Care Medicine, an invaluable source of up-to-date information, with the curriculum of both the Primary and Final FRCA examinations covered over a three-year cycle. Published monthly this ever-updating text book will be an invaluable source for both trainee and experienced anaesthetists. The enthusiastic editorial board, under the guidance of two eminent and experienced series editors, ensures Anaesthesia and Intensive Care Medicine covers all the key topics in a comprehensive and authoritative manner. Articles now include learning objectives and eash issue features MCQs, facilitating self-directed learning and enabling readers at all levels to test their knowledge. Each issue is divided between basic scientific and clinical sections. The basic science articles include anatomy, physiology, pharmacology, physics and clinical measurement, while the clinical sections cover anaesthetic agents and techniques, assessment and perioperative management. Further sections cover audit, trials, statistics, ethical and legal medicine, and the management of acute and chronic pain.