Neuroprotective Effects of Propofol in Acute Cerebral Injury

Chiara Adembri, Luna Venturi, Domenico E. Pellegrini-Giampietro
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引用次数: 96

Abstract

Propofol (2,6-diisopropylphenol) is one of the most popular agents used for induction of anesthesia and long-term sedation, owing to its favorable pharmacokinetic profile, which ensures a rapid recovery even after prolonged administration. A neuroprotective effect, beyond that related to the decrease in cerebral metabolic rate for oxygen, has been shown to be present in many in vitro and in vivo established experimental models of mild/moderate acute cerebral ischemia. Experimental studies on traumatic brain injury are limited and less encouraging. Despite the experimental results and the positive effects on cerebral physiology (propofol reduces cerebral blood flow but maintains coupling with cerebral metabolic rate for oxygen and decreases intracranial pressure, allowing optimal intraoperative conditions during neurosurgical operations), no clinical study has yet indicated that propofol may be superior to other anesthetics in improving the neurological outcome following acute cerebral injury. Therefore, propofol cannot be indicated as an established clinical neuroprotectant per se, but it might play an important role in the so-called multimodal neuroprotection, a global strategy for the treatment of acute injury of the brain that includes preservation of cerebral perfusion, temperature control, prevention of infections, and tight glycemic control.

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异丙酚在急性脑损伤中的神经保护作用
异丙酚(2,6-二异丙酚)是最常用的药物之一,用于诱导麻醉和长期镇静,因为它具有良好的药代动力学特征,即使在长时间给药后也能确保快速恢复。在许多体外和体内建立的轻度/中度急性脑缺血实验模型中,除了与脑氧代谢率降低相关的神经保护作用外,还显示出一种神经保护作用。创伤性脑损伤的实验研究是有限的,不太令人鼓舞。尽管实验结果和对脑生理学的积极作用(异丙酚减少脑血流量,但保持与脑氧代谢率的耦合并降低颅内压,在神经外科手术中提供最佳的术中条件),但尚未有临床研究表明异丙酚在改善急性脑损伤后神经预后方面可能优于其他麻醉剂。因此,异丙酚本身不能作为一种临床神经保护剂,但它可能在所谓的多模式神经保护中发挥重要作用,这是一种治疗急性脑损伤的全球策略,包括保持脑灌注、控制温度、预防感染和严格控制血糖。
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