全身麻醉患儿术后不良行为改变的研究进展

Negative postoperative behaviors in children under general anesthesia

背景围手术期对于儿童来说是一个应激的过程,全身麻醉患儿常出现术后不良行为改变（negative postoperative behavioral changes,NPOBC）（如夜间噩梦、遗尿、无故发脾气等）,影响小儿情感及认知的发育.目的 加强对全身麻醉患儿NPOBC的认识,降低患儿NPOBC发生率,改善患儿预后.内容主要介绍与全身麻醉患儿NPOBC相关的危险因素、可能机制及干预措施.趋向 α2受体激动剂及现代神经影像技术可能为降低患儿NPOBC提供新思路.关于高危易感患儿（如早产儿、合并神经行为问题的儿童）NPOBC的研究仍存在很大的空白.

Background Children, elected to major surgeries under general anesthesia, experience tremendous stress during perioperative period, and the stress may be associated with negative postoperative behavioral changes （NPOBC）, such as nightmares, enuresis, temper tantrum, etc, which may affect both emotional and cognitive development in these children. Objective To promote the awareness of NPOBC, meanwhile, to probe risk factors for its intervention to reduce the incidence of NPOBC and improve the prognosis of these children. Content Clinical trials reveal multiple potential risk factors for NPOBC, including young ages （〈4 years old）, introvert personality, perioperative anxiety, perioperative algesia, period （〉4 d） in hospital, etc. These abnormal behaviors could relate to toxic effects of anesthetics on neuronal development, differentiation, connections, and apoptosis. Moreover, neuroinflammation initiated during surgery and the release of stress hormones in perioperative period could also contribute to these behaviors. Several strategies were implemented in several investigations, including administration of benzodiazepine antidepressant drugs or 2-adrenoceptor agonists, enhancement of support from family, and alteration of anesthetic procedure, etc. However, none of these interventions has convincing effectiveness. Trend There still lacks causal links between the risk factors mentioned above and the incidence of NPOBC. Additionally, the molecular, cellular, and circuit mechanisms underlying NPOBC require further multidisciplinary investigations, which may eventually provide avenues for the treatment and intervention of these behaviors.