在麻醉和手术中预防中枢神经系统并发症(双语).ppt

The assumption that anesthesia has no serious, long-term, adverse CNS consequences is probably true for most patients 假设麻醉没有严重的，长期的，中枢神经系统的不良后果，可能是适用于大多数患者。 However, for patients younger than 6 months, or older than 60 years, that assumption is under challenge from a substantial body of evidence. 然而，对于年龄小于6个月或年龄超过60岁的患者，这种假设受到大量证据的挑战。 Fetuses and newborns appear to be at risk because systems that would enable them to fully recover from the effects of more than 2 hours of anesthesia are still in development. In distinction, seniors may be at risk because systems that once enabled full recovery have ever-diminishing capacity. Even for some patients between the age of 6 months and 60 years, full recovery may require replacing apoptosed neurons and pruning dendritic spines … perhaps leaving them not quite the same person that they were before they were anesthetized. 胎儿和新生儿似乎处于危险之中，因为使他们能够从多于2个小时的麻醉中完全恢复的系统仍然在发育中。相对的，老年人可能存在风险是因为可以使他们完全恢复的系统已经日益衰竭。甚至对6个月以下和60岁以上的一些患者中，完全恢复可能需要更换凋亡神经元和修剪树突棘...或许会使他们变得和麻醉前不一样的人。 Factors Aggravating Factors加重的因素 - On-pump vs. Off-pump体外循环与非体外循环 - Inflammation 炎症 - Anesthetics麻醉药 - Deeper vs. Lighter Regional vs. General Anesthesia更深与更浅和区域与全身麻醉 - Anesthesia and Neurodegenerative Diseases 麻醉与神经退行性疾病 Potential Alleviating Factors潜在的缓解因素 - Anesthetics麻醉药 - A Grab Bag of Adjuvants各种辅助剂 - Preconditioning预处理 - Neurogenesis神经再生 Aggravating Factors加重的因素 （1）On-pump vs. Off-pump Does on-pump versus off-pump make a neurocognitive difference? More recently, Puskas and colleagues found that “After a mean of 7.5 years of follow-up, patients undergoing off-pump coronary artery bypass performed better than those undergoing [on-pump] cardiopulmonary bypass in several neuropsychological domains,”and in a sort of positive-control study, Li et al found that preconditioning with hyperbaric oxygen reduced markers of cerebral injury in patients undergoing on-pump bypass but not in patients having off pump bypass, reasoning that “the protective effects of