全身麻醉对剖宫产新生儿神经退行性变生物标志物及认知功能影响的病例对照研究  

The impact of general anesthesia on biomarkers of neurodegeneration and cognitive function in newborns after cesarean delivery:aprospective case-control study

作　　者：周静兰 周瑶 周依露 陶伟民 徐振东 ZHOU Jing-lan;ZHOU Yao;ZHOU Yi-lu(Department of Anesthesiology,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,Shanghai 201024,China)

机构地区：[1]同济大学附属第一妇婴保健院手术麻醉科,上海201204

出　　处：《中国实验诊断学》2022年第3期336-341,共6页Chinese Journal of Laboratory Diagnosis

基　　金：上海市卫生健康临床专项基金(201840149)。

摘　　要：目的 研究全身麻醉对剖宫产新生儿脐血内神经退行性变生物标志物以及生长期认知发育等功能的影响。方法 纳入在2018年9月至2019年9月间于本院行择期全麻剖宫产的产妇135名(全麻组),及同期入院行椎管内麻醉剖宫产的产妇135名(椎管内麻醉组)。在胎儿娩出后采集2组的脐动脉和脐静脉血,测定血气和神经退行性变生物标志物(S100、Tau蛋白和Activin A)。在儿童生长到12和24月龄时,通过Bayley-III评估量表随访和评估其认知、语言等发育功能情况。结果 椎管内麻醉组的低血压发生率要高于全麻组(P<0.05),全麻组新生儿1min的Apgar评分则低于椎管内麻醉组(P<0.05)。但是2组间脐动、静脉血的血气、S100、Tau蛋白和Activin A均无差异。2组儿童在认知、语言、身体动作、社会性情绪、适应行为等5个维度中也未见明显差异。多因素分析显示麻醉方案与Bayley-III量表评分之间无显著联系。结论 剖宫产期间短时间的全身麻醉可能并不影响新生儿的神经发育。Objective To investigate the impact of general anesthesia on biomarkers of neurodegeneration and cognitive function in newborns after cesarean delivery.Methods One hundred and thirty-five pregnant women undergoing elective cesarean delivery(CD)under general anesthesia were included from September 2018to September 2019in our hospital,while 135pregnant women receiving CD with spinal anesthesia were selected as control group.The brain damage biomarkers(S100,Tau protein and Activin A)of umbilical artery and vein were compared between the two groups.Bayley-III scale was used to assess neurodevelopment at age 12months and 24months.Results The incidence of hypotension is higher in spinal anesthesia group than in general anesthesia group(P<0.05).Compared with spinal anesthesia,general anesthesia resulted in the lower 1min Apgar score of neonates(P<0.05).There were no significant difference between two groups when comparing the brain damage biomarkers(S100,Tau protein and Activin A)and BayleyIII scales.Multivariate analysis showed no significant relationship between anesthesia regimen and Bayley III scale scores.Conclusion Short term exposure of general anesthesia during cesarean section may not affect long-term cognition development of newborns.

关 键 词：全身麻醉 剖宫产 神经毒性 认知发育 

分 类 号：R719.8[医药卫生—妇产科学]