新生儿心脏手术镇静/镇痛药物的使用对学龄前期神经发育状况的影响

Effect of neonatal perioperative anesthetic exposure in cardiac surgery on neurodevelopmental outcomes in preschool children

目的探讨新生儿心脏手术的麻醉暴露对学龄前期（48~72个月）的神经发育结果的影响。方法选取四川省人民医院行心脏手术的新生儿89例,纳入队列研究,收集一般资料、围手术期镇静/镇痛药物使用情况等相关变量,在研究对象进入学龄前期应用韦氏学前和学龄儿童智力测定量表（第3版）、Beery-Buktenica视觉运动整合发育测验（第4版）、适应行为评定系统（第2版）的一般适应综合分数评估神经发育状况。结果共有71例研究对象最终纳入研究,经多重线性回归分析,苯二氮卓类药物时间（β=-0.49,P=0.005）、苯二氮卓类药物累积剂量（β=-0.10,P=0.023）与FSIQ有关,苯二氮卓类药物时间（β=-0.39,P=0.009）、水合氯醛使用天数（β=-1.19,P=0.020）与PIQ有关,苯二氮卓类累积使用剂量与VMI的得分有关（β=-0.008,P=0.012）。其他镇静/镇痛药物使用的有关变量与FSIQ、PIQ、VIQ、VMI或GAC的相关性未发现统计学意义。结论新生儿心脏手术围手术期的苯二氮卓类药物时间、苯二氮卓类药物累积剂量、水合氯醛使用天数与学龄前期神经发育情况有关。需要采取针对性的措施,降低围手术期可导致神经损伤的药物因素。

Objective To evaluate the effect of neonatal perioperative anesthetic exposure in complex cardiac surgery on neurodevelopmental outcomes in preschool children. Methods General clinical data and data concerning anesthetic exposure were collected from 89 infants undergoing complex cardiac surgery at Sichuan People＇s Hospital. The cohort was followed for neurodevelopment till preschool age（48-72 months） and assessed with Wechsler Preschool and Primary Scale of IntelligenceIII, Beery-Buktenica Developmental Test of Visual Motor Integration（VMI-V）, and General Adaptive Composite（GAC） of the Adaptive Behavior Assessment System-II. Results Seventy-one children were enrolled into the final analysis. Multiple linear regression found days on benzodiazepines（β=-0.49, P=0.005） and cumulative dose of benzodiazepines（β=-0.10, P=0.023） were associated with the full- scale IQ in these preschool children. Days on benzodiazepines（β =- 0.39, P=0.009） and on chloral hydrate（β =- 1.19, P=0.020） were associated with lower performance intelligence quotient（PIQ） at the preschool age.Cumulative dose of benzodiazepine exposure（β =- 0.008, P=0.012） was associated with lower VMI scores. No correlations of other sedation/analgesia variables were found with the full- scale IQ, PIQ, Verbal IQ, VMI, or GAC scores. Conclusion We found a significant association of days on benzodiazepines, cumulative dose of benzodiazepines, and days on chloral hydrate in neonatal cardiac surgery with neurodevelopmental outcomes at the preschool age, suggesting the need of minimizing anesthetic exposure during a neonatal cardiac surgery to improve the children＇s neurodevelopmental outcomes.