吸入麻醉药与脑保护的研究进展_West China Medical Journal

Authors：

 李钰 , 陈烽烽 ,  陈向东

四川大学华西医院麻醉科（成都，610041）;

Corresponding author：

陈向东, Email: xiangdong_chen@yahoo.com

Keywords：

吸入麻醉药; 脑保护

DOI：

10.7507/1002-0179.20140172

Video：

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围手术期间由于手术本身的影响以及血流动力学变化可以导致全身各个系统、器官特别是脑缺血等损伤，因此对大脑等重要器官的保护是临床重要课题。围麻醉期间所使用的吸入麻醉剂很早就被报道有器官保护作用，大量动物实验已经证实吸入麻醉药的预处理和后处理有脑保护作用。其脑保护作用机制主要涉及调节钙离子浓度，降低谷氨酸盐的神经毒性，抑制N-甲基-D-天冬氨酸受体活性等。现对吸入麻醉药脑保护作用的不同影响因素及可能的作用机制进行综述。

Citation： 李钰, 陈烽烽, 陈向东. 吸入麻醉药与脑保护的研究进展. West China Medical Journal, 2014, 29(3): 568-571. doi: 10.7507/1002-0179.20140172 Copy

1.	Nasu I, Yokoo N, Takaoka S, et al. The dose-dependent effects of isoflurane on outcome from severe forebrain ischemia in the rat[J]. Anesth Analg, 2006, 103(2):413-418.
2.	Popovic R, Liniger R, Bickler PE. Anesthetics and mild hypothermia similarly prevent hippocampal neuron death in an in vitro model of cerebral ischemia[J]. Anesthesiology, 2000, 92(5):1343-1349.
3.	Lasarzik I, Noppens RR, Wolf T, et al. Dose-dependent influence of sevoflurane anesthesia on neuronal survival and cognitive outcome after transient forebrain ischemia in Sprague-Dawley rats[J]. Neurocrit Care, 2011, 15(3):577-584.
4.	Lee HM, Lee DH, Choi JH, et al. Sevoflurane-induced post-conditioning has no beneficial effects on neuroprotection after incomplete cerebral ischemia in rats[J]. Acta Anaesthesiol Scand, 2010, 54(3):328-336.
5.	Zhu W, Wang L, Zhang L, et al. Isoflurane preconditioning neuroprotection in experimental focal stroke is androgen-dependent in male mice[J]. Neuroscience, 2010, 169(2):758-769.
6.	Kitano H, Young JM, Cheng J, et al. Gender-specific response to isoflurane preconditioning in focal cerebral ischemia[J]. J Cereb Blood Flow Metab, 2007, 27(7):1377-1386.
7.	Zhan X, Fahlman CS, Bickler PE. Isoflurane neuroprotection in rat hippocampal slices decreases with aging:changes in intracellular Ca2+ regulation and N-methyl-D-aspartate receptor-mediated Ca2+ influx[J]. Anesthesiology, 2006, 104(5):995-1003.
8.	Kawaguchi M, Kimbro JR, Drummond JC, et al. Isoflurane delays but does not prevent cerebral infarction in rats subjected to focal ischemia[J]. Anesthesiology, 2000, 92(5):1335-1342.
9.	Li L, Zuo Z. Isoflurane preconditioning improves short-term and long-term neurological outcome after focal brain ischemia in adult rats[J]. Neuroscience, 2009, 164(2):497-506.
10.	Blanck TJ, Haile M, Xu F, et al. Isoflurane pretreatment ameliorates postischemic neurologic dysfunction and preserves hippocampal Ca2+/calmodulin-dependent protein kinase in a canine cardiac arrest model[J]. Anesthesiology, 2000, 93(5):1285-1293.
11.	McMurtrey RJ, Zuo Z. Isoflurane preconditioning and postconditioning in rat hippocampal neurons[J]. Brain Res, 2010, 1358(13):184-190.
12.	Patel PM, Drummond JC, Cole DJ, et al. Isoflurane reduces ischemia-induced glutamate release in rats subjected to forebrain ischemia[J]. Anesthesiology, 1995, 82(4):996-1003.
13.	Engelhard K, Werner C, Hoffman WE, et al. The effect of sevoflurane and propofol on cerebral neurotransmitter concentrations during cerebral ischemia in rats[J]. Anesth Analg, 2003, 97(4):1155-1161.
14.	Nishizawa Y. Glutamate release and neuronal damage in ischemia[J]. Life Sci, 2001, 69(4):369-381.
15.	Warner DS, Zhou JG, Ramani R, et al. Reversible focal ischemia in the rat:effects of halothane, isoflurane, and methohexital anesthesia[J]. J Cereb Blood Flow Metab, 1991, 11(5):794-802.
16.	Tobin JR, Martin LD, Breslow MJ, et al. Selective anesthetic inhibition of brain nitric oxide synthase[J]. Anesthesiology, 1994, 81(5):1264-1269.
17.	Galley HF, Nelson LR, Webster NR. Anaesthetic agents decrease the activity of nitric oxide synthase from human polymorphonuclear leucocytes[J]. Br J Anaesth, 1995, 75(3):326-329.
18.	Hoetzel A, Geiger S, Loop T, et al. Differential effects of volatile anesthetics on hepatic heme oxygenase-1 expression in the rat[J]. Anesthesiology, 2002, 97(5):1318-1321.
19.	Hall AC, Lieb WR, Franks NP. Stereoselective and non-stereoselective actions of isoflurane on the GABAA receptor[J]. Br J Pharmacol, 1994, 112(3):906-910.
20.	Sun XD, Xu LX, Zhang H, et al. Effects of enflurane anesthesia on the neurotransmitters in different areas of the canine cerebrum[J]. J Pract Med, 2006, 22(13):1488-1490.
21.	Philip E. Bickler, MD David S. γ-Aminobutyric Acid-A receptors contribute to isoflurane neuroprotection in organotypic hippocampal cultures[J]. Anesth Analg, 2003, 97(2):564-571.
22.	Ye Z, Guo Q, Xia P, et al. Sevoflurane postconditioning involves an up-regulation of HIF-1α and HO-1 expression via PI3K/Akt pathway in a rat model of focal cerebral ischemia[J]. Brain Res, 2012, 1463:63-74.
23.	Lin HY, Yeh WL, Huang BR, et al. Desipramine protects neuronal cell death and induces heme oxygenase-1 expression in Mes23.5 dopaminergic neurons[J]. PLoS One, 2012, 7(11):e50138.
24.	Ballanyi K. Protective role of neuronal KATP channels in brain hypoxia[J]. J Exp Biol, 2004, 207(Pt 18):3201-3212.
25.	Kehl F, Payne RS, Roewer N, et al. Sevoflurane-induced preconditioning of rat brain in vitro and the role of KATP channels[J]. Brain Res, 2004, 1021(1):76-81.

1. Nasu I, Yokoo N, Takaoka S, et al. The dose-dependent effects of isoflurane on outcome from severe forebrain ischemia in the rat[J]. Anesth Analg, 2006, 103(2):413-418.
2. Popovic R, Liniger R, Bickler PE. Anesthetics and mild hypothermia similarly prevent hippocampal neuron death in an in vitro model of cerebral ischemia[J]. Anesthesiology, 2000, 92(5):1343-1349.
3. Lasarzik I, Noppens RR, Wolf T, et al. Dose-dependent influence of sevoflurane anesthesia on neuronal survival and cognitive outcome after transient forebrain ischemia in Sprague-Dawley rats[J]. Neurocrit Care, 2011, 15(3):577-584.
4. Lee HM, Lee DH, Choi JH, et al. Sevoflurane-induced post-conditioning has no beneficial effects on neuroprotection after incomplete cerebral ischemia in rats[J]. Acta Anaesthesiol Scand, 2010, 54(3):328-336.
5. Zhu W, Wang L, Zhang L, et al. Isoflurane preconditioning neuroprotection in experimental focal stroke is androgen-dependent in male mice[J]. Neuroscience, 2010, 169(2):758-769.
6. Kitano H, Young JM, Cheng J, et al. Gender-specific response to isoflurane preconditioning in focal cerebral ischemia[J]. J Cereb Blood Flow Metab, 2007, 27(7):1377-1386.
7. Zhan X, Fahlman CS, Bickler PE. Isoflurane neuroprotection in rat hippocampal slices decreases with aging:changes in intracellular Ca2+ regulation and N-methyl-D-aspartate receptor-mediated Ca2+ influx[J]. Anesthesiology, 2006, 104(5):995-1003.
8. Kawaguchi M, Kimbro JR, Drummond JC, et al. Isoflurane delays but does not prevent cerebral infarction in rats subjected to focal ischemia[J]. Anesthesiology, 2000, 92(5):1335-1342.
9. Li L, Zuo Z. Isoflurane preconditioning improves short-term and long-term neurological outcome after focal brain ischemia in adult rats[J]. Neuroscience, 2009, 164(2):497-506.
10. Blanck TJ, Haile M, Xu F, et al. Isoflurane pretreatment ameliorates postischemic neurologic dysfunction and preserves hippocampal Ca2+/calmodulin-dependent protein kinase in a canine cardiac arrest model[J]. Anesthesiology, 2000, 93(5):1285-1293.
11. McMurtrey RJ, Zuo Z. Isoflurane preconditioning and postconditioning in rat hippocampal neurons[J]. Brain Res, 2010, 1358(13):184-190.
12. Patel PM, Drummond JC, Cole DJ, et al. Isoflurane reduces ischemia-induced glutamate release in rats subjected to forebrain ischemia[J]. Anesthesiology, 1995, 82(4):996-1003.
13. Engelhard K, Werner C, Hoffman WE, et al. The effect of sevoflurane and propofol on cerebral neurotransmitter concentrations during cerebral ischemia in rats[J]. Anesth Analg, 2003, 97(4):1155-1161.
14. Nishizawa Y. Glutamate release and neuronal damage in ischemia[J]. Life Sci, 2001, 69(4):369-381.
15. Warner DS, Zhou JG, Ramani R, et al. Reversible focal ischemia in the rat:effects of halothane, isoflurane, and methohexital anesthesia[J]. J Cereb Blood Flow Metab, 1991, 11(5):794-802.
16. Tobin JR, Martin LD, Breslow MJ, et al. Selective anesthetic inhibition of brain nitric oxide synthase[J]. Anesthesiology, 1994, 81(5):1264-1269.
17. Galley HF, Nelson LR, Webster NR. Anaesthetic agents decrease the activity of nitric oxide synthase from human polymorphonuclear leucocytes[J]. Br J Anaesth, 1995, 75(3):326-329.
18. Hoetzel A, Geiger S, Loop T, et al. Differential effects of volatile anesthetics on hepatic heme oxygenase-1 expression in the rat[J]. Anesthesiology, 2002, 97(5):1318-1321.
19. Hall AC, Lieb WR, Franks NP. Stereoselective and non-stereoselective actions of isoflurane on the GABAA receptor[J]. Br J Pharmacol, 1994, 112(3):906-910.
20. Sun XD, Xu LX, Zhang H, et al. Effects of enflurane anesthesia on the neurotransmitters in different areas of the canine cerebrum[J]. J Pract Med, 2006, 22(13):1488-1490.
21. Philip E. Bickler, MD David S. γ-Aminobutyric Acid-A receptors contribute to isoflurane neuroprotection in organotypic hippocampal cultures[J]. Anesth Analg, 2003, 97(2):564-571.
22. Ye Z, Guo Q, Xia P, et al. Sevoflurane postconditioning involves an up-regulation of HIF-1α and HO-1 expression via PI3K/Akt pathway in a rat model of focal cerebral ischemia[J]. Brain Res, 2012, 1463:63-74.
23. Lin HY, Yeh WL, Huang BR, et al. Desipramine protects neuronal cell death and induces heme oxygenase-1 expression in Mes23.5 dopaminergic neurons[J]. PLoS One, 2012, 7(11):e50138.
24. Ballanyi K. Protective role of neuronal KATP channels in brain hypoxia[J]. J Exp Biol, 2004, 207(Pt 18):3201-3212.
25. Kehl F, Payne RS, Roewer N, et al. Sevoflurane-induced preconditioning of rat brain in vitro and the role of KATP channels[J]. Brain Res, 2004, 1021(1):76-81.

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