儿童早期2 h以内全身麻醉手术暴露对学龄期神经发育的影响  

Effects of surgical procedures and general anesthesia exposure within 2 hours in early childhood on neurodevelopmental outcomes in school-age

作　　者：王建设 占文强[2] 费建 王谦倩[3] 李远程 顾小萍 Wang Jianshe;Zhan Wenqiang;Fei Jian;Wang Qianqian;Li Yuancheng;Gu Xiaoping(Department of Anesthesiology,Drum Tower Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Anesthesiology,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Children Health Care,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China;School of Public Health,Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]南京医科大学鼓楼临床医学院麻醉科,南京210008 [2]南京医科大学附属儿童医院麻醉科,南京210008 [3]南京医科大学附属儿童医院儿童保健科,南京210008 [4]南京医科大学公共卫生学院,南京211166

出　　处：《中华医学杂志》2023年第5期356-363,共8页National Medical Journal of China

摘　　要：目的观察儿童早期2 h以内全身麻醉手术暴露对学龄期神经发育的影响。方法回顾性选择2009年6月至2012年12月在南京医科大学附属儿童医院接受全身麻醉外科手术(时间<2 h)时0~2岁,且入选本研究时(2018年6月至2021年12月)为6~12岁的学龄期儿童为暴露组,共147例,其中男76例,女71例,年龄(8.8±1.6)岁;根据不同麻醉暴露次数分为单次暴露组(n=65)和多次暴露组(≥2次,n=82)。按照暴露组队列匹配同期(2018年6月至2021年12月)社区招募的同龄、无全身麻醉手术史的健康儿童为健康对照组,共160名,其中男87名,女73名,年龄(8.6±1.9)岁。由专业儿童保健科医师对所有受试者进行多种标准化神经测试,包括韦氏儿童智力量表第四版中文版(WISC-Ⅳ)、整合视听连续执行测试(IVA-CPT)、注意缺陷多动障碍量表(SNAP-Ⅳ)、感觉统合能力发展量表中文版(CSIC)和社会生活能力量表。主要观察指标为WISC-Ⅳ中的全量表总智商(FSIQ),次要观察指标为IVA-CPT、SNAP-Ⅳ、CSIC和社会生活能力量表得分。结果单次暴露组、多次暴露组和健康对照组FSIQ分别为105.4±14.1、100.9±10.2和103.6±13.5,差异无统计学意义(F=2.37,P=0.095);0~6个月、7~12个月和1~2岁首次暴露年龄组的FSIQ分别为99.8±10.2、104.5±10.5和104.4±14.5,差异无统计学意义(F=2.39,P=0.095);暴露0~59 min组、暴露60~119 min组和健康对照组FSIQ分别为102.8±11.3、103.0±13.7和103.6±13.5,差异无统计学意义(F=0.13,P=0.882)。在次要观察结果中,单次暴露组、多次暴露组和健康对照组IVA-CPT的视觉持续性商数分别为94.8±10.5、94.0±10.9和100.6±17.7,差异有统计学意义(F=6.96,P=0.001);社会生活能力量表的运动得分分别为(10.0±0.2)、(10.2±0.6)和(10.4±0.7)分,差异有统计学意义(F=10.61,P<0.001),但均在标准范围内。结论儿童早期2 h以内的全身麻醉手术暴露对学龄期整体FSIQ没有影响,对IVA-CPT的视觉持续性商数以及�Objective To observe the effect of surgical procedures and general anesthesia exposure(<2 h)in early childhood on neurodevelopmental outcomes in school-age.Methods A total of 147 children aged 6-12 years old,who received surgery under general anesthesia(<2 h)at the age of 0-2 years in Children′s Hospital of Nanjing Medical Universityfrom June 2009 to December 2012 were retrospectively enrolled in this study(from June 2018 to December 2021)as exposure group,including 76 males and 71 females,with a mean age of(8.8±1.6)years.All the cases were divided into single-exposure group(n=65)and multiple-exposure group(≥2 times,n=82)according to different times of anesthesia exposure.According to the cohort of exposure group,160 healthy children of the same age with no history of surgery under general anesthesia were recruited from the community from June 2018 to December 2021 as the control group,including 87 males and 73 females,and aged(8.6±1.9)years.A variety of standardized neurological tests including Wechsler intelligence scale for children fourth edition(WSC-Ⅳ),integrated visual and auditory continuous performance test(IVA-CPT),Swanson Nolan and Pelham,versionⅣ(SNAP-Ⅳ),children sensory integration capacity development rating scale(CSIC),and social living ability scale were performed in all subjects by a child health specialist who failed to know the details.The primary outcome was the full-scale IQ(FSIQ)in WISC-Ⅳ,and the secondary outcomes were IVA-CPT,SNAP-Ⅳ,CSIC,and social living ability scale.Results The FSIQ of single-exposure,multiple-exposure and control groups was 105.4±14.1,100.9±10.2 and 103.6±13.5,respectively,with no statistically significant difference(F=2.37,P=0.095).The FSIQ of different first age exposure groups(aged 0-6 months,7-12 months and 1-2 years)was 99.8±10.2,104.5±10.5 and 104.4±14.5,respectively,with no statistically significant difference(F=2.39,P=0.095).The FSIQ of different exposure duration groups(0-59 min,60-119 min and control group)was 102.8±11.3,103.0±13.7 and

关 键 词：儿童 全身麻醉 学龄期 神经发育 

分 类 号：R726.1[医药卫生—儿科]