国际麻醉学与复苏杂志   2017, Issue (11): 2-2
    
丙泊酚对发育期大脑影响的研究进展
吴晓倩, 李建立, 容俊芳1()
1.河北医科大学研究生学院,河北省人民医院
Effects of propofol on the developing brain
 全文:
摘要:

背景 随着小儿外科手术技术的快速发展,婴幼儿在全身麻醉下接受治疗日益普遍。丙泊酚作为小儿临床麻醉常用药,其对发育期大脑的影响受到社会广泛关注。 目的 综述丙泊酚对发育期大脑影响的研究进展,为今后有关研究及小儿安全用药提供参考。 内容 以丙泊酚对发育期大脑影响及其机制予以综述,并进一步阐述其防治措施。 趋向 未来研究需进一步探究丙泊酚对发育期大脑影响机制,寻找安全、有效的防治措施,使小儿麻醉更加安全可靠。

关键词: 丙泊酚; 发育期大脑
Abstract:

Background Propofol is commonly used in pediatric surgery, while its detrimental effects on neurobehavior in children subjected to surgery are recognized in the field, and attract more and more attention from scientists. Objective To describe the adverse effects of propofol on the developing brain, and to summarize potential interventional and therapeutic strategies to prevent or reverse neurobehavioral dysfunctions following propofol anesthesia. Content Propofol confers its anesthetic efficacy by regulating gamma amino acid(GABA) and N-methyl-D-aspartate (NMDA) receptors. Because of the unique characteristics of neurons and neural circuit connections in the developing brain, propofol exceptionally interferes brain functions at both cellular and circuit levels. Propofol has been demonstrated to disrupt calcium homeostasis, elevating intracellular calcium concentrations, and to inhibit the synthesis of mature neurotrophic factors. These cellular events may contribute to propofol-induced cellular and circuit outcomes, such as, neuronal apoptosis, imbalance of excitatory and inhibitory drives to neurons, loss of synaptic plasticity, and enhancement of inflammatory reaction. Accumulating experimental evidence shows that 17-estradiol, dexmedetomidine, acetyl-L-carnitine, erythropoietin, and lithium salts have therapeutic potentials to propofol-induced dysfunctions on developing brain. Trend Most toxicological and therapeutic experiments were conducted in animals. More sophisticated mechanistic experiments and clinical trials are warranted to advance our understanding of neuro-pathophysiological bases of propofol, and to provide new avenue for interventional and therapeutic strategies to treat Propofol-induced neural dysfunctions.

Key words: Propofol; Developing brain