学龄前儿童围术期认知功能和行为改变的麻醉相关因素分析

Analysis of Anesthesia Related Factors for Perioperative Cognitive Function and Behavioral Changes in Preschool Children

目的初步分析围术期导致小儿认知和行为功能改变的麻醉相关因素。方法大样本观察并有效随访温州医科大学附属第二医院2012~2017年期间接受择期非神外非心外手术行全身麻醉的4~7岁学龄前患儿共17854例,将患儿分别按照麻醉方法(静脉麻醉和吸入麻醉)、术中有无低氧血症、低血压、低体温、输血、阿托品使用和胶体使用输血等分组,统计分析导致围术期小儿认知和行为功能改变的麻醉相关因素。结果17854例患儿中,术后发生认知和行为功能改变者为1.82%(325例)。其中吸入麻醉组发生率显著高于静脉麻醉组(302 vs 23例,1.93%vs 1.00%,P<0.05);术中发生低氧血症组(185例,6.80%)较无低氧血症组发生率显著增高(140例,0.93%,P<0.05);术中发生低血压组(54例,3.30%)较无低血压组显著增高(271例,1.67%,P<0.05);术中发生低体温组(243例,6.27%)较无低体温组显著增高(82例,0.59%,P<0.05);有无使用阿托品、胶体和输血分析比较差异均无统计学意义(P均>0.05)。多因素Logistic回归分析发现术中低氧血症、低血压、低体温和使用吸入麻醉均是患儿发生围术期认知功能和行为改变的危险因素(OR=4.66,2.34,10.59,1.72),曲线下面积发现以上因素的ROC值分别为0.91、0.79、0.89、0.76。结论术中低氧血症、低体温、低血压和使用吸入麻醉是患儿发生围术期认知功能和行为改变的独立危险因素。

Objective To analyze the anesthesia related factors for perioperative cognitive function and behavioral change(PCFBC)in preschool children during the perioperative period.Methods A total of 17854 preschool children,aged 4-7 years who received general anesthesia and non-neurosurgery and non-cardiac-chest surgery operation during 2012 to 2017 in the Second Affiliated Hospital of Wenzhou Medical University,were observed and followed up in this large-scale study.The children were categorized according to the anesthesia method(intravenous anesthesia and inhalation anesthesia)and events of intra-operative hypoxemia,hypotension,hypothermia,blood transfusion,atropine use,and colloid use.Statistics analysis was used to explore the anesthesia related factors for perioperative cognitive function and behavioral changes.Results A total of 325 children(1.82%)occurred PCFBC in 17854 cases,in which,the incidence of PCFBC in inhalation anesthesia group was significantly higher compared with intravenous anesthesia group(302 vs 23 cases,1.93%vs 1.00%,P<0.05).The incidence of hypoxemia group(185 cases,6.80%)was significantly higher compared with non-hypoxemia group(140 cases,0.93%,P<0.05).The incidence of PCFBC in hypotension group(54 cases,3.30%)was significantly higher than that in non-hypotension group(271 cases,1.67%,P<0.05).It was also higher in hypothermia group(243 cases,6.27%)when compared with non-hypothermia group(82 cases,0.59%,P<0.05).There was no statistically significant difference in presence or absence of atropine,colloid and blood transfusion groups(P>0.05).Multivariate Logistic regression analysis found that intraoperative hypoxemia,hypotension,hypothermia,and inhaled anesthesia were risk factors for PCFBC in children(OR=4.66,2.34,10.59,1.72),the area under the curve found above factors of ROC were 0.91,0.79,0.89,and 0.76,respectively.Conclusion Intraoperative hypoxemia,hypothermia,hypotension,and inhaled anesthesia were the independent risk factors for PCFBC in preschool children.