Morrison Gavin, Fraser Douglas D, Cepinskas Gediminas
Paediatric Critical Care Medicine, University of Western Ontario, London, ON, Canada.
Pathophysiology. 2013 Feb;20(1):49-57. doi: 10.1016/j.pathophys.2012.02.006. Epub 2012 Apr 10.
The brain of the infant and young child is a developing, dynamic, structure subject to functional remodelling under the influence of factors responsible for optimal neuronal development and synaptogenesis. It exhibits age dependent variation in metabolic rate, blood flow, and ability to tolerate oxidative stress. It is also characterized by an exuberance of neurotransmitter activity, particularly in the first few years of life. The dynamic evolution and adaptability of early brain function permits the organization of neuronal networks to be influenced by environmental stimulation, and, to reduce the functional impact of injury. However, these same processes may also exacerbate the harm sustained by the brain following an acquired brain injury (ABI). The developing neurons are susceptible to excitotoxicity, oxidative stress, and, inflammation, often leading to cellular necrosis and apoptosis. Despite being immunologically privileged via the blood brain barrier, the developing brain is susceptible to injury from systemic inflammation through alteration of normally protective cerebrovascular endothelial cell function. Finally, many of the therapeutic agents currently employed in post-ABI hospital care may also compromise ABI outcome via non-intended pharmacological effects. These agents include analgesic, sedative and anti-convulsant medications. This review emphasizes those physiological considerations in the developing brain which may impact the outcome after ABI, including, the cellular mechanisms of neuronal and cerebrovascular endothelial cell injury, ABI outcome and future therapeutic directions.
婴幼儿的大脑是一个正在发育的、动态的结构，在负责最佳神经元发育和突触形成的因素影响下会发生功能重塑。它在代谢率、血流量和耐受氧化应激的能力方面表现出与年龄相关的变化。其特点还包括神经递质活动旺盛，尤其是在生命的最初几年。早期脑功能的动态演变和适应性使得神经网络的组织能够受到环境刺激的影响，并减少损伤的功能影响。然而，这些相同的过程也可能会加剧后天性脑损伤（ABI）后大脑所遭受的损害。发育中的神经元易受兴奋性毒性、氧化应激和炎症的影响，常常导致细胞坏死和凋亡。尽管通过血脑屏障具有免疫特权，但发育中的大脑由于正常保护性脑血管内皮细胞功能的改变，易受全身炎症的损伤。最后，目前在ABI后医院护理中使用的许多治疗药物也可能通过非预期的药理作用损害ABI的预后。这些药物包括止痛、镇静和抗惊厥药物。本综述强调了发育中大脑的那些可能影响ABI后预后的生理因素，包括神经元和脑血管内皮细胞损伤的细胞机制、ABI的预后以及未来的治疗方向。
