氯胺酮神经保护与神经毒性的研究进展

Research progress on neuroprotective effect and neurotoxicity of ketamine

氯胺酮是一种具有高度脂溶性、起效迅速的麻醉药物,主要通过非竞争性地抑制N-甲基-D-天冬氨酸受体(NMDAR)发挥作用,然而由于其可能伴随的幻觉、妄想、身心分离等精神分裂症样表现以及潜在的成瘾性很长一段时间内在临床麻醉中应用较少。如今随着对氯胺酮抗抑郁、抗炎、神经保护等作用的研究不断深入,氯胺酮在国内的应用正逐步扩展。但是氯胺酮也具有神经毒性,一定条件下会引起神经细胞凋亡,尤其是作用于发育期大脑时。本文针对氯胺酮的神经保护与神经毒性作用两种特性,其相关机制以及通过氯胺酮与其他麻醉药物的复合运用来更好地利用其神经保护,减少神经毒性进行综述。

Ketamine is a highly fat-soluble and fast-acting anesthetic drug,which acts mainly through the non-competitive inhibition of N-methyl-D-aspartate receptor(NMDAR).However,it may be accompanied with hallucinations,delusions,psychosomatic separation,schizophrenia-like manifestations and potential addiction.As a result,it once faded out of the mainstream in clinical anesthesia.Nowadays,with the discovery of antidepressant,anti-inflammatory and neuroprotective effects of ketamine,it has been used more and more widely in China.However,ketamine is also neurotoxic and can cause nerve cell apoptosis under certain conditions,especially in the developing brain.This paper aims at the two characteristics of neuroprotective effect and neurotoxicity of ketamine,its related mechanism and how to make better use of its neuroprotective effect and reduce neurotoxicity through the combined use of ketamine and other narcotic drugs.