颅脑创伤（traumatic brain injury, TBI）多发生于青壮年，且中重度患者预后差，给社会和家庭带来沉重负担。此类患者常需接受麻醉下手术治疗，近年来，麻醉药物对TBI后继发性脑损伤的影响引起了广泛关注。文章总结了TBI后继发性脑损伤的病理生理机制及麻醉药物对其进程的可能影响。继发性脑损伤的主要环节为神经炎症反应，其发生机制包括：免疫细胞激活、炎症介质上调、补体系统激活、交感神经系统激活、血脑屏障通透性改变等。麻醉药物对于神经炎症反应的影响不一，现有研究多局限于动物实验，应进一步开展人体研究探索这一问题，以期优化TBI患者的麻醉管理。
Traumatic brain injury (TBI) often occurs in young adults. It brings heavy burden to society and family because of the poor outcome. Most patients need to receive surgery under anesthesia. In recent years, the impact of anesthetics on secondary brain injury after TBI has attracted wide attention. This review summarizes the pathophysiological mechanisms of secondary brain injury after TBI and the impact of anesthetics on them. Neuroinflammation plays an important role in secondary brain injury of TBI. The mechanism of neuroinflammation includes activation of immune cells, up‑regulation of inflammatory mediators, activation of complement system, activation of sympathetic nervous system and alteration of blood‑brain barrier permeability. Anesthetics have different effects on neuroinflammation. Most previous studies are animal experiments. The impact of anesthetics on neuroinflammation should be further studied in human in order to improve the anesthetic management of TBI patients.
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