摘要
术后认知功能障碍(POCD)是一种常见的术后并发症。大量研究结果表明,手术或麻醉药品引起的神经炎症是POCD发生的主要原因。托烷司琼为5-羟色胺3受体拮抗剂,同时是一种α7烟碱乙酰胆碱受体部分激动剂,可以通过调节多个炎症通路,如胆碱能抗炎通路、p38丝裂原活化蛋白激酶信号通路、环腺苷酸-蛋白激酶A-环磷腺苷效应元件结合蛋白信号通路和P物质/神经激肽1受体信号通路等,降低中枢炎症水平,同时可以作用于神经退行性疾病的关键靶点α7烟碱乙酰胆碱受体,调节胆碱能抗炎通路从而介导免疫系统,也可以通过抑制氧化损伤、线粒体功能障碍和炎症介质过度产生,促进沉默信息调节因子1蛋白的表达,延缓脑老化所致神经退行性疾病。因此,托烷司琼作为围手术期常用的止吐药,在临床应用中发现其同时具有一定的神经保护特性,可以改善POCD。本文对托烷司琼改善围手术期认知功能的机制进行简单综述。
Postoperative cognitive dysfunction(POCD) is a common postoperative complication. A large number of studies have shown that neuroinflammation induced by surgery or narcotic drugs is the main cause of POCD. Tropisetron, as an antagonist of 5-hydroxytryptamine 3 receptor, is an α7nicotinic acetylcholine receptor(α7nAchR) partial agonist, which can reduce central inflammation by regulating multiple inflammatory pathways such as cholinergic anti-inflammatory pathway, p38MAPK signal pathway, cAMP-PKA-CREB signal pathway and SP/NK1R signal pathway, and act on key targets α7nAchR of neurodegenerative diseases, regulate the cholinergic anti-inflammatory pathway to mediate the immune system, and also promote the expression of SIRT1 protein and delay neurodegenerative diseases caused by brain aging by reducing the inhibition of oxidative damage, mitochondrial dysfunction and excessive production of inflammatory mediators. Therefore, as a commonly used antiemetic drug in perioperative period, tropisetron has been found to have a certain neuroprotective properties in clinical application, which can improve POCD. This thesis provides a brief review of the mechanism of tropisetron in improving perioperative cognitive function.
作者
李玉才
张栋斌
张维亮
迟永良
LI Yucai;ZHANG Dongbin;ZHANG Weiliang;CHI Yongliang(the First School of Clinical Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250000,China;Dept.of Anesthesiology,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250000,China)
出处
《中国医院用药评价与分析》
2022年第10期1277-1280,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
山东省自然科学基金面上项目(No.ZR2021MH168)
山东省中医药科技发展计划项目(No.2019-0176)。
关键词
托烷司琼
认知功能
中枢炎症
乙酰胆碱
阿尔茨海默病
Tropisetron
Cognitive function
Central inflammation
Acetylcholine
Alzheimer’s disease
