麻醉药的心脑保护作用：最新临床研究证据及展望

Cardio-neuroprotection of anesthetic agents： recent clinical evidence and perspectives

麻醉药的心脑保护作用一直广受关注，但仍存在一些争议。尽管多数临床前研究发现常用麻醉药能减轻缺血／缺氧性心脑损伤，但临床研究却未得到确定性结论。综述近年来关于麻醉药心脑保护作用的临床研究，尤其是随机对照研究，结果表明，多数常用的麻醉药（吸人性麻醉药异氟醚、七氟醚，静脉麻醉药丙泊酚、右美托咪定等）均表现出一定的心脏保护作用，其中氟烷类吸入性麻醉药较静脉麻醉药效果更明显，可显著减轻心脏手术患者的心肌损伤。静脉麻醉药中，右美托咪定对心脏手术患者的心肌保护作用在大样本临床研究中得到验证。麻醉药的脑保护作用存在较大争议，也缺少简单、客观的疗效评价指标，还应开展大规模、多中心的临床研究。

Background The cardio-neuroprotective effect of anesthetics has been widely concerned but still controversial. Although strong preclinieal data support that anesthetics could attenuate ischemic/hypoxic myocardial and cerebral injury, confirmative conclusions have not been demonstrated from clinical studies. We reviewed clinical trials in recent years （especially randomized controlled trials） on cardio-neuroprotection of commonly used anesthetic agents （volatile anesthetics： isoflurane, sevoflurane, intravenous anesthetics： propofol, dexmedetomidine ）. Among the mostly studied anesthetics that reveal the property of cardio-neuroprotection, ether-derived volatile anesthetics have shown more promising potentials than intravenous anesthetics, especially in cardiac surgeries. The cardio-neuroprotection of intravenous anesthetic dexmedetomidine was validated in heart surgery by randomized controlled trial with large sample. However, the neuroprotection of anesthetic agents is controversial, and there＇s lack of simple and objective evaluation indicators for it. Thus, large-scale, multicenter clinical trials are necessary in the future.