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手术麻醉对学龄前儿童发育的影响
作者:邓城旗 李萌萌 杨静 房晓燕 孟令超 
单位:121000  辽宁锦州 锦州医科大学研究生院(邓城旗、孟令超) 100048  北京 解放军总医院第四医学中心麻醉科(邓城旗、李萌萌、杨静、房晓燕、孟令超) 
关键词:麻醉 儿童 丹佛发育筛查测试 神经发育 
分类号:R971
出版年,卷(期):页码:2019,44(1):31-36
摘要:

[摘要]  目的  分析手术麻醉对学龄前儿童发育的影响。方法  选择201751日-201851日就诊于解放军总医院第四医学中心拟行手术的0~6岁患儿445例作为研究对象,根据不同试验目的,对儿童进行如下分组:①根据儿童既往手术麻醉史,将其分为手术麻醉组(GA组,n=120)和未经历手术麻醉组(Non-GA组,n=325);并选择同期本院幼儿园儿童作为空白对照组(Naive组,n=168);②根据儿童曾经历手术麻醉的次数将GA组分为3个亚组:单次麻醉组(Single)、两次麻醉组(Twice)、三次及以上多次麻醉组(Multiple);③根据儿童经历手术麻醉累计总时长,将GA组分为<3h组与3h组。收集和总结入组儿童基本情况和手术麻醉暴露情况,由专业人员为儿童进行丹佛发育筛查测试(DDST),观察0~6岁不同组儿童DDST结果,以及手术麻醉次数和手术麻醉总时间对DDST结果的影响。结果  在0~6岁儿童中,Naive组、Non-GA组及GA组的DDST筛查阳性率分别为6.0%6.5%12.5%,其中Naive组与Non-GA组相比差异无统计学意义(P=0.825),而与Non-GA组相比,GADDST阳性率显著增高,差异有统计学意义(P=0.038)。对DDST各能区进行比较发现,GA组儿童比Non-GA组儿童在个人-社会方面表现较差,差异有统计学意义(P=0.025)。在0~3(3)儿童中,Non-GA组与GA组患儿的DDST阳性率分别为3.9%18.6%,差异有统计学意义(P=0.019),而3~6岁儿童各组间比较差异无统计学意义(P>0.05)。在GA组中,经历单次、两次及多次手术麻醉的儿童,其DDST阳性率差异无统计学意义(P=0.784),但手术麻醉总时长3h患儿的DDST阳性率为18.7%,与<3h患儿(DDST阳性率2.2%)相比,差异有统计学意义(P=0.008)  经历手术麻醉对学龄前儿童,尤其0~3岁儿童的发育有一定影响。手术麻醉总时间可能与儿童发育障碍呈正相关。

[Abstract]  Objective  To investigate the effects of anesthesia on neurodevelopment of preschool children. Methods  A total of 445 children, scheduled to undergo surgery in the Fourth Medical Center of Chinese PLA General Hospital from 1st May 2017 to 1st May 2018, were enrolled and, according to different test purpose, grouped as follows: (1) 120 children (GA group) who underwent surgery before Denver Developmental Screening Test (DDST) were matched to 325 unexposed children (Non- GA group). Meanwhile, 168 children (Naive group) were measured as blank control. (2) According to the number of anesthesia that children had undergone, those in GA group were assigned to three subgroups: single, twice and multiple groups. (3) Subgroup analyses was performed based on the time of cumulative duration of anesthesia exposures (less than 3 and greater than or equal to 3h). Data were collected with a questionnaire to evaluate the children's physical development, DDST results were recorded, and the effects were evaluated of the number of anesthesia and the time of cumulative duration of anesthesia exposures on the DDST results. Results  For the children aged 0 to 6 yr, the DDST positive rates in Naive, Non-GA and GA groups were 6.0%, 6.5% and 12.5%, respectively. No significant difference existed in DDST positive rate between Naive group and Non-GA group (P=0.825). Compared with Non-GA group, the DDST positive rate increased in GA group (6.5% vs. 12.5%) with significant difference (P=0.038). Compared among the four domains of DDST separately, statistical difference was found only in terms of personal-social, those in GA group showed poor performance than in Non-GA group (P=0.025). For the children aged less than 3 yr, the DDST positive rates in GA group and Non-GA group were 18.6% and 3.9%, respectively, showing significant differences (P=0.019), but no statistical difference was found on DDST positive rate among the three groups of children aged 3 to 6 yr (P>0.05). In GA group, there was no increase in odds of early developmental vulnerability with increasing frequency of anesthesia exposure (P=0.784). However, the DDST positive rate was significantly higher with longer cumulative duration of anesthesia exposure (3h) than that of <3h (18.7% vs. 2.2%, P=0.008). Conclusions  Exposure to anesthesia is an increased risk for the later neurodevelopment of preschool children, especially before 3 years old. The time of cumulative duration of anesthesia may be positively correlated to the children's neurodevelopment disabilities.

基金项目:
国家自然科学基金(81272030);吴阶平医学基金会临床科研专项资助基金(320.6750.13220)
作者简介:
邓城旗,硕士研究生。主要从事发育期麻醉药物对认知功能影响的研究
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