全身麻醉与儿童神经认知功能发育异常相关性的研究  

Study on the correlation between general anesthesia and abnormal neurodevelopmental outcomes in children

作　　者：廖过英 钟林宏 王帆 陈天楠 高毅 戚传宇 严佳[1] LIAO Guoying;ZHONG Linhong;WANG Fan;CHEN Tiannan;GAO Yi;QI Chuanyu;YAN Jia(Department of Anesthesiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海市200011 [2]上海交通大学医学院,上海市200025

出　　处：《组织工程与重建外科》2024年第2期220-226,共7页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的本研究旨在揭示全身麻醉与儿童神经认知功能发育异常的相关性。方法本研究为回顾性队列研究。以2017年1月至2020年12月间在我院接受全身麻醉手术的3岁以下患儿作为麻醉组,2022年9月至2023年8月期间未接受过全麻手术且年龄3~6岁的门诊或住院儿童为对照组。在2022年9月至2023年8月期间,使用0~6岁《儿童发育筛查父母问卷》对研究对象的认知功能发育是否异常进行筛查和评估。比较两组间不同因子得分之间的差异,评估校正混杂因素后全身麻醉与儿童生长发育结果之间的相关性。对儿童接受麻醉时的年龄进行分层分析,评价不同年龄段儿童接受全身麻醉后神经认知功能发育情况。结果共336名患儿纳入本研究,对照组和麻醉组分别为132例和204例。对照组接受评估时平均年龄为(4.8±1.2)岁,麻醉组接受评估时平均年龄为(4.8±1.2)岁,两组无统计学差异(P>0.05)。麻醉组儿童与对照组儿童相比,在精细运动、适应行为、语言和社会和生活自理因子方面的得分较低,差异具有统计学意义(P<0.05);校正混杂因素后,手术麻醉仍然对适应行为和语言因子有影响(P<0.05)。根据接受手术麻醉时年龄进行分层分析后发现,0~1岁接受全麻手术与适应行为及社会和生活自理因子得分较低有关(P<0.05);2~3岁接受全麻手术与语言因子得分较低有关(P<0.05)。结论幼年时接受全身麻醉与适应行为、语言方面的神经认知不良有关。不同年龄段接受全身麻醉对特定神经功能区的发育有不同影响。Objective To investigate the correlation between general anesthesia and neurodevelopmental outcomes in children.Methods This retrospective cohort study included children under 3 years old who received general anesthesia in our hospital from January 2017 to December 2020 as the anesthesia group,and outpatient or inpatient children aged 3 to 6 years old who did not receive general anesthesia during September 2022 to August 2023 as the control group.From September 2022 to August 2023,the study population was assessed for abnormal neurodevelopmental outcomes by the mental developmental screening test(DST)at 0-6 years of age.The DST evaluated gross motor,fine motor,language,adaptive behavior,and social and self-care.The t-tests were conducted to compare scores on different dimensions between the two groups.Linear regression analyses were performed to assess the associations between general anesthesia and children's neurodevelopmental outcomes after adjusting for con-founders.Stratified analyses were conducted to explore the impact of general anesthesia on neurodevelopmental outcomes in children based on different age ranges of exposure.Results A total of 336 children participated in the study,with 132 in the control group and 204 in the anesthesia group.The testing age was(4.8±1.2)years in both the control and anesthesia groups,and there was no statistically significant difference(P>0.05).Compared with control group,children in the anesthesia group had lower scores in fine motor,adaptive behavior,language,and social and self-care,with statistically significant difference(P<0.05).After adjusting for con-founders,the effects of anesthesia on the adaptive behavior and language remained significant(P<0.05).Stratification analysis according to the age at the time of anesthesia showed that general anesthesia at 0-1 year old was associated with lower scores of adaptive behavior and social and self-care factors(P<0.05),and general anesthesia at 2 to 3 years old was associated with lower language factor scores(P<0.05).Conclus

关 键 词：全身麻醉 儿童 神经发育 问卷调查 

分 类 号：R614.2[医药卫生—麻醉学]