应用韦氏智力量表评估全身麻醉下牙齿治疗对儿童的影响

Children's intelligence quotient following general anesthesia for dental care: a clinical observation by Chinese Wechsler young children scale of intelligence

目的：观察全身麻醉（全麻）下牙齿治疗前后短期内儿童智力的变化。方法：收集2011年11月至2013年1月北京大学口腔医院儿童口腔科4.0-6.5岁接受全麻下牙齿治疗的全身健康状况良好患者32例,使用七氟醚、笑气、丙泊酚对患者进行全麻,按诊疗操作常规在全麻下完成牙齿治疗。在全麻治疗术前1周及术后2周左右分别使用中国-韦氏学龄前和学龄初期智力量表（城市版）对其进行智力测评。结果：最终完成术前和术后智力测验的患者28人,麻醉时间为（163.4±32.6）min,治疗牙数为（12.1±2.3）颗,其全麻治疗术后的总智商（intelligence quotient,IQ）为128.46±10.85,显著高于术前总智商124.64±11.46（P=0.017）,总智商增加主要来源于操作智商的增加,操作智商术前为125.14±11.73,术后为129.68±10.33（P=0.007）;而语言智商变化不明显,术前119.68±11.74,术后为120.21±15.61（P=0.854）。结论：使用七氟醚、笑气、丙泊酚对4.0-6.5岁儿童所进行的2-4 h的全麻下牙齿治疗在短期内儿童的韦氏智力量表评分没有下降,而术后儿童智商的增加可以用记忆效应解释。

Objective： It has been demonstrated that anesthetics exposure may lead to neurocognitive impairment in developing brain of animal models. However,for the limitation that the animal models cannot fully mimic the dose and duration in clinical settings especially for dental general anesthesia,the clinical significance of anesthetics exposure on developing central nervous system remains undetermined.Therefore,we conducted the current study in order to observe the fluctuation of intelligence quotient（ IQ） after the administration of dental general anesthesia comparing to that before surgery. We conducted the current study in order to observe the fluctuation of intelligence quotient（ IQ） after the administration of dental general anesthesia compared with that before surgery. Methods： Thirty two patients,ASA Ⅰ,who were exposed to dental general anesthesia in Department of Pediatric Dentistry Peking University School and Hospital of Stomatology,aged 4 to 6. 5 years,were enrolled in this prospective study. Patients with severe learning difficulties or communication disorders were excluded. Written and informed consent was obtained from each patients＇ family which was fully explained of the purpose and method of study.Their intelligence quotients were evaluated with the Chinese Wechsler young children scale of intelligence（ Urban version） before and 2 weeks after dental anesthesia. They were treated by experienced pediatric dentists and the sevoflurane,propofol and nitrous oxide were used for general anesthesia by anesthetist.Articaine hydrochloride and epinephrine tartrate injections were used for their pulp treatment or extraction. The examiners and scorers for IQ had technical training in the test administration. All the patients were tested by the same examiner and with standardized guide language. Each subtest was scored according to the tool review. Verbal IQ and performance IQ consisted of relevant 5 subtests and full scale IQ.Statistical analyses were performed by SPSS 18. 0. All the scores of subtests and 3 types of IQ were expressed as x珋± s. Paired two-tailed t test was applied and P〈0. 05 was accepted as statistically significant. Results： The results of intelligent assessment from 28 subjects were collected. The anesthetic time was（ 163. 4 ± 32. 6） min and the number of treated teeth was 12. 1 ± 2. 3,mean age（ 4. 60 ± 0. 41）years; age range = 4. 04 to 5. 44 years. Among the patients,there were 13 girls and 15 boys. There was no significant difference in gender distribution. The postoperative full IQ（ 128. 46 ± 10. 85） was higher than that before surgery（ 124. 64 ± 11. 46,P = 0. 017）. We found that the elevation of performance IQ,to a large extent,contributed to this change in full IQ（ P = 0. 007）. Correspondingly,there was no statistical difference in the verbal IQ,which was 119. 68 ± 11. 74 to 120. 21 ± 15. 61（ P = 0. 854）. Conclusion： Dental general anesthesia has no negative effect on the intelligence of preschool children,who were treated under general anesthesia by sevoflurane,propofol and nitrous oxide for 2 to 4 hours. The full IQ and performance IQ were slightly enhanced after treatment which can be explained by the memory effect.