全身麻醉药物对发育期大脑影响的争鸣

摘要

A growing number of studies in immature animal models demonstrate that general anesthesia induced neuron apoptosis and cognitive impairment in adult animals after neonatal anesthesia. However, the evidence for anesthesia-induced neuron apoptosis in animal models is controversial. It remains unclear whether anesthesia induces pathological apoptosis or premature physiological one, and there are limited data in clinical studies that suggest the causal relationship between neurocognitive impairment and neonatal anesthesia exposure. Besides, as different species show different anesthetic doses and susceptibility periods, there is the huge gap between the experimental models and clinical pediatric anesthesia practice. Still, the clinical phenotype of anesthesia-induced neurocognitive impairment remains elusive. Identification of the underlying mechanism is of paramount importance, and more multi-center prospective clinical studies are necessary to assess the effect of anesthesia during early childhood and guide pediatric anesthesia. This paper reviews recent evidence on the effect of general anesthetics on the developing brain.%麻醉药物作用于N-甲基-D-天冬氨酸(NMDA)受体和(或)γ氨基丁酸(GABA)引起发育期动物大脑神经退行性变和成年后认知功能障碍,且神经元凋亡或功能受损具有年龄、接触时间和剂量的依赖性.然而麻醉药物诱导神经细胞凋亡的假说仍存在争议.麻醉药物引起的凋亡是病理性凋亡还是生理性凋亡及其与与神经认知功能障碍间的因果关系尚不清楚.动物实验中不同种属动物麻醉/镇痛所需要的药物剂量、发育易感期各不相同,因此动物实验结果不能直接应用于临床.临床上全麻药物对婴幼儿神经毒性的临床研究证据尚不充分,仍需进一步获取多中心、大样本人类研究数据,以证实麻醉药物与发育期大脑退行性变的因果关系,阐述其机制,指导临床医师的工作.本文综述了全身麻醉药物对发育期大脑影响的研究进展.