近年来，随着对外科重症病人病理生理认识的进一步提高，使严重创伤和感染的危重病人得到及时、有效的救治，明显缩短了病程，改善了预后。在此过程中，营养支持治疗是一项重要的内容。由于严重应激导致下丘脑-垂体-肾上腺轴（HPA）及各种炎性介质大量激活，必然会对体内的主要营养物质，如：糖、脂、蛋白质等的代谢产生严重影响。了解这些营养物质的病理生理变化机制，对指导合理的营养支持治疗具有重要意义。

Changes of metabolism in surgical critically ill patients and the significance for clinical nutrition     CAI Chang-jie. SICU, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Abstract    In recent years, with a better understanding of the surgical critically ill patients’pathophysiology, the timely, effective treatments could give them who have severe trauma and infection. The treatments can significantly shorten the course of the disease and improve the prognosis. In the process, nutritional support is an important content. Due to an activation of HPA axis and a variety of inflammatory mediators, serious impact will occur to the metabolism of the main nutrients, such as: sugar, fat, protein and so on. Understanding of the pathophysiology alteration mechanism of the nutrients, it will better guide surgeons to perform rational nutritional support.