全身麻醉对儿童神经发育影响的临床研究进展

Clinical Progress in Effect of General anesthesia on Neurodevelopment in Children

目的探讨全身麻醉对儿童神经发育影响的临床研究进展。方法从动物实验的研究结果出发,提出开展全身麻醉对儿童神经发育影响的临床研究的意义和价值。从儿童神经发育状况评价标准,即:入学测试或学业成绩、临床诊断、神经心理测试,展开全身麻醉对儿童神经发育影响的观察性研究总结及分析;以一个具体案例,即:全麻与腰麻的比较(GAS)研究,展开全身麻醉对儿童神经发育影响的试验性研究总结及分析。结果动物实验提示发育期大脑暴露于多种全身麻醉药物后出现了远期脑功能损害,观察性研究的文献表明婴幼儿时期接受全身麻醉不会导致长期神经发育的明显落后,以全麻与腰麻的比较(GAS)研究为代表的试验性研究表明低于1 h的七氟醚麻醉也不会导致患儿的神经发育异常。结论短小单一的全身麻醉一般不会影响儿童的神经发育,多次麻醉暴露可能会引起处理速度及精细运动能力等发育迟缓,但不应该因全身麻醉暴露引起的微弱神经发育异常而推迟必要的手术治疗。

Objective To summarize the clinical progress in the effect of general anesthesia on neurodevelopment in children.Methods Based on the results of animal experiments,the significance and value of clinical research on the effect of general anesthesia on children’s neurodevelopment are proposed.According to the evaluation criteria of children’s neurodevelopmental status(school readiness or academic performance,clinical diagnosis,neuropsychological testing results),the observational studies on the effect of general anesthesia on children’s neurodevelopment are summarized and analyzed,and the experimental summary and analysis are carried out based on a specific GAS study(general anesthesia compared to spinal anesthesia).Results Animal experiments suggested that exposure to a variety of general anesthetic drugs caused a long-term dysfunction in the developing brain.Observational studies showed that general anesthesia in infants did not lead to obvious abnormities in long-term neurodevelopment.GAS-based experimental studies showed that sevoflurane anesthesia for less than 1 hour did not resulted in abnormal neurodevelopment in children.Conclusion Short and single general anesthesia generally does not affect neurodevelopment in children.Multiple anesthetic exposures may cause developmental retardation including processing speed and fine motor ability.However,the necessary surgery should not be delayed due to the mild neurodevelopmental disorders caused by general anesthesia exposure.