全身麻醉剂对发育期大脑神经元凋亡的影响及其机制

Effect and mechanism of general anesthetics induced neurodegeneration in the developing brain

动物实验发现全身麻醉剂可引起发育期大脑神经元广泛凋亡和长期神经认知功能障碍。内源性及外源性凋亡途径均参与麻醉药物引起的细胞凋亡,而信号传导机制尚不明确,某些药物可能减轻麻醉引起的神经细胞凋亡。然而全麻药物神经毒性作用的临床研究证据尚不充分,尚需进一步多中心、大样本人类研究的支持。

Recent reports from animal studies provide mounting evidence that exposure to anesthetics during the period of rapid synaptogenesis triggers widespread neuronal apoptosis in the developing brains and causes significant long-term neurocognitive impairment.Animal studies have confirmed that both the intrinsic and extrinsic pathways of the apoptotic cascade are involved in anesthetics induced apoptotic neurodegeneration.However,the exact cell signaling mechanisms for activation of the apoptotic cascade and cellular selectivity remains unclear.Recent preliminary data from human clinical studies is still scarce and has not demonstrated causal relationships between long-term developmental and behavioral disorders following surgery and anesthesia early in life.Further animal studies and well-designed clinical studies are needed to examine the mechanisms,clinical relevance and promising protecting strategies.