全身麻醉下进行手术治疗的婴幼儿的大脑发育影响因素分析

Analysis of factors influencing the brain development in infants received operation under general anesthesia

目的:回顾性分析全身麻醉下接受手术治疗的婴幼儿的大脑发育影响因素。方法:选取0~3岁期间在广西医科大学第一附属医院接受过全身麻醉进行手术治疗的3~6岁儿童为实验组(n=447),并根据实验组儿童的年龄、性别、种族等按照1∶1匹配原则选取0~3岁期间未接受全身麻醉及手术的3~6岁儿童作为相应对照组(n=459)。根据麻醉记录单将患儿按手术部位分为四肢手术组(A_(1)组)、下腹部手术组(A_(2)组)、上腹部手术组(A_(3)组)、头面部手术组(A_(4)组)、会阴部手术组(A_(5)组);按手术时体重分为<5 kg组(B_(1)组)、5~10 kg组(B_(2)组)、>10~15 kg组(B_(3)组)、>15 kg组(B_(4)组);按手术时年龄分为0~5月组(C_(1)组)、6~12月组(C_(2)组)、>1~2岁组(C_(3)组)、>2~3岁组(C_(4)组);按住院天数分为1~5天组(D_(1)组)、>5~10天组(D_(2)组)、>10天组(D_(3)组);按手术时长分为<1 h组(E_(1)组)、1~2 h组(E_(2)组)、>2 h组(E_(3)组);按民族分为汉族组(F_(1)组)、壮族组(F_(2)组)、其它民族组(F_(3)组);按性别分为女孩组(G_(1)组)、男孩组(G_(2)组)。应用韦氏幼儿智力量表第四版(WPPSI-IV)、学龄前儿童行为学评分量表(CBCL)和盖塞尔发展量表(Gesell)对上述婴幼儿的神经认知发育进行评估。结果:实验组韦氏量表的工作记忆指数(WMI)得分(97.51±8.35)分明显低于对照组WMI得分(102.03±11.52)分(P<0.05)。与B_(1)组比较,B_(2)组、B_(3)组、B_(4)组的总智商(FSIQ)、WMI、发育商数(DQ)值得分升高(均P<0.05);与B_(2)组比较,B_(3)组、B_(4)组的FSIQ、WMI得分升高,B_(4)组的CBCL得分降低(均P<0.05);与B_(3)组比较,B_(4)组的FSIQ得分升高(P<0.05)。与C_(1)组比较,C_(2)组的DQ值得分升高,C_(3)组、C_(4)组的FSIQ得分升高,C_(4)组的WMI得分升高(均P<0.05);与C_(2)组比较,C_(3)组、C_(4)组的FSIQ得分升高,C_(4)组的WMI得分升高(P<0.05)。与D_(3)组比较,D_(1)组、D_(2)组的FSIQ、WMI、DQ值得分均升高(均P<0.05)。与E_(3)组比较,E_(1)组、E_(2)组的FSIQ,WMI,DQ值得分均升高(均P<0.05)。结论:手术时年龄越小、体重越低、手术时间越长,则出现神经发育不良事件的风险越大。

Objective:To retrospectively analyze the influencing factors of brain development of infants who received surgery under general anesthesia.Methods:The children aged 3-6 years who received surgery under general anesthesia during 0-3 years age in our hospital were selected as experimental group(n=447).Children aged 3-6 years who had not received general anaesthesia and surgery during 0-3 years age were selected as the control group(n=459) according to a 1∶1 matching based on age,gender and ethnicity of the experimental group children.According to the operation site,the children were divided into four groups:limbs surgery group(A1),lower abdominal surgery group(A2),upper abdominal surgery group(A3),head and face surgery group(A4),and perineum surgery group(A5).According to the weight at the time of surgery,the children were divided into <5 kg group(B1),>5-10 kg group(B2),>10-15 kg group(B3),and >15 kg group(B4).According to the age at the time of surgery,the children were divided into 0-5 months group(C1),6-12 months group(C2),1-2 years group(C3),and 2-3 years group(C4).According to the hospital days,the children were divided into 1-5 days group(D1),>5-10 days group(D2),>10 days group(D3).According to operation duration,the children were divided into 1 h group(E1),1-2 h group(E2),and 2 h group(E3).According to the nationality,the children were divided into Han group(F1),Zhuang group(F2),and other ethnic group(F3).The girls were defined as group G1 and boys were group G2.The neurocognitive development of the infants were evaluated by Wechsler Intelligence scale for Young Children(WPPSI-IV),Behavioral rating scale for Preschool Children(CBCL) and Gesell Development scale.Results:The scores of working memory index(WMI) of Wechsler scale in the experimental group(97.51 ± 8.35) were significantly lower than that in the control group(102.03±11.52)(P<0.05).The scores of total IQ,WMI and DQ of group B_(2),group B_(3) and group B_(4) were higher than those of group B_(1).The scores of total IQ and WMI of group B_(3) and group B_(4) were higher than those of group B_(2),and the score of CBCL was decreased in group B_(4).The score of FSIQ of group B_(4) was lower than those of group B_(3)(P<0.05).Compared with group C_(1),the DQ score was increased in group C_(2),the FSIQ score was increased in group C_(3) and group C_(4),and WMI score was increased in group C_(4).Compared with group C_(2),the FSIQ score was increased in group C_(3) and group C_(4),and WMI score was elevated in group C_(4)(P<0.05).Compared with group D_(3),the scores of FSIQ,WMI and DQ of group D_(2) and group D_(1) were significantly increased(P<0.05).Compared with group E_(3),group E_(1) and group E_(2) exhibited higher FSIQ,WMI and DQ scores(P<0.05).Conclusion:The younger the age at the time of operation,the lower the body weight,and the longer the operation time,the risk of adverse neurodevelopmental events will be higher.