Wang Hailian, Li Peiying, Xu Na, Zhu Ling, Cai Mengfei, Yu Weifeng, Gao Yanqin
Anesthesiology Department of Huashan Hospital, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; Pittsburgh Institute of Brain Disorders and Recovery, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Pittsburgh Institute of Brain Disorders and Recovery, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Med Gas Res. 2016 Dec 30;6(4):194-205. doi: 10.4103/2045-9912.196901. eCollection 2016 Oct-Dec.
Cerebral ischemic stroke is a leading cause of serious long-term disability and cognitive dysfunction. The high mortality and disability of cerebral ischemic stroke is urging the health providers, including anesthesiologists and other perioperative professioners, to seek effective protective strategies, which are extremely limited, especially for those perioperative patients. Intriguingly, several commonly used inhalational anesthetics are recently suggested to possess neuroprotective effects against cerebral ischemia. This review introduces multiple paradigms of inhalational anesthetic treatments that have been investigated in the setting of cerebral ischemia, such as preconditioning, proconditioning and postconditioning with a variety of inhalational anesthetics. The pleiotropic mechanisms underlying these inhalational anesthetics-afforded neuroprotection against stroke are also discussed in detail, including the common pathways shared by most of the inhalational anesthetic paradigms, such as anti-excitotoxicity, anti-apoptosis and anti-inflammation. There are also distinct mechanisms involved in specific paradigms, such as preserving blood brain barrier integrity, regulating cerebral blood flow and catecholamine release. The ready availability of these inhalational anesthetics bedside and renders them a potentially translatable stroke therapy attracting great efforts for understanding of the underlying mechanisms.
脑缺血性中风是导致严重长期残疾和认知功能障碍的主要原因。脑缺血性中风的高死亡率和高致残率促使包括麻醉医生和其他围手术期专业人员在内的医疗服务提供者寻求有效的保护策略，但这类策略极为有限，尤其是针对那些围手术期患者。有趣的是，最近有研究表明几种常用的吸入麻醉药对脑缺血具有神经保护作用。本综述介绍了在脑缺血背景下已被研究的多种吸入麻醉药治疗模式，例如使用多种吸入麻醉药进行预处理、预适应处理和后处理。还详细讨论了这些吸入麻醉药对中风具有神经保护作用的多效性机制，包括大多数吸入麻醉药模式共有的常见途径，如抗兴奋毒性、抗细胞凋亡和抗炎作用。特定模式中还涉及不同的机制，如维持血脑屏障完整性、调节脑血流量和儿茶酚胺释放。这些吸入麻醉药在床边即可获得，使其成为一种潜在的可转化的中风治疗方法，吸引了人们为了解其潜在机制付出巨大努力。
