全麻药物对神经发育影响的争鸣

The Debate about the Effects of General Anesthesia on Neurodevelopment

每年有大量的婴幼儿在全身麻醉下接受各种检查和治疗,麻醉药物的安全问题也成为人们日益关注的问题,全麻药物作用于发育期大脑是否会产生持续性不可逆损伤这一问题,被学者所担忧。虽然动物研究提示了全麻药物具有神经毒性,但临床研究结论并不一致,需要有更多的研究予以探索,并通过合理的用药手段、保护手段,将麻醉药品的副作用降低到最低。本文从基础研究和临床研究方面,简述了当前全身麻醉药对神经发育影响的研究现状,介绍了现有研究的成果和局限性。分析了全麻药物神经毒性可能存在的时间依赖性和剂量依赖性。目前更多的研究趋向于单次、相对短时间的麻醉下手术对神经发育影响很小,未来期待更多的研究予以探索全麻药物神经毒性作用,特别是大剂量重复麻醉暴露对发育期神经的生长影响,从而更好地指导临床治疗。

General anesthetics are widely used in millions of neonates and infants for operations and medical examination every year. The safety of anesthetic has also become a growing concern. Although animal studies show the anesthetic neurotoxicity, it is confusing that the current clinical researches are not consistent. More studies are needed to investigate the anesthetic neurotoxicity and minimize the side effect of anesthetic. This article describes the advantages and limitations of animal and clinical researches on anesthetic neurotoxicity in recent years, shows the time-dependence and dose-dependence of anesthetic neurotoxicity Evidence in recent studies suggesting that single, relatively brief exposures to surgical procedures requiring general anesthesia are not associated with detectable deficits in neurodevelopment. It is essential that more studies are needed to investigate the association between anesthesia and neurodevelopment, especially the multiple expose, and to guide the practice.