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2017年5月1日-2018年5月1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组)、两次麻醉组(Twice组)、三次及以上多次麻醉组(Multiple组);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%和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,GA组DDST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岁(含3岁)儿童中,Non-GA组与GA组患儿的DDST阳性率分别为3.9%和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)。结论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。
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 1 st May2017 to 1 st 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(NonGA 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 to3 h). 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 increasi
作者
邓城旗
李萌萌
杨静
房晓燕
孟令超
DENG Cheng-qi;LI Meng-meng;YANG Jing;FANG Xiao-yan;MENG Ling-chao(Graduate School,Jinzhou Medical University,Jinzhou,Liaoning 121000,China;Department of Anesthesiology,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2019年第1期31-36,共6页
Medical Journal of Chinese People's Liberation Army
基金
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)~~
关键词
麻醉
儿童
丹佛发育筛查测试
神经发育
anesthesia
children
Denver Developmental Screening Test
neurodevelopment
