单次全身麻醉对学龄前儿童神经发育的影响

Effects of a single general anesthesia on neurodevelopment in preschool children

目的评价单次全身麻醉对学龄前儿童神经发育的影响。方法拟接受全身麻醉或非全身麻醉儿童,性别不限,年龄3~6周岁,ASA分级Ⅰ或Ⅱ级。全身麻醉组儿童接受全身麻醉下口腔治疗,对照组儿童接受口腔窝沟封闭治疗。全身麻醉组父母陪伴患儿进入手术室,吸入50%氧化亚氮+8%七氟烷,静脉注射丙泊酚2 mg/kg、芬太尼2μg/kg、顺阿曲库铵0.1 mg/kg和地塞米松0.2 mg/kg,可视喉镜引导下经鼻气管插管后行机械通气,吸入2.5%~3.0%七氟烷维持麻醉。于麻醉前和麻醉后6个月时进行韦氏幼儿智力量表、执行功能评定量表及适应行为评定量表评分。结果全身麻醉组44例,对照组19例。2组儿童麻醉前和术后6个月韦氏幼儿智力量表、儿童适应性行为评定量表和执行功能评定量表各项评分变化量比较差异均无统计学意义(P>0.05)。结论单次全身麻醉对学龄前儿童神经发育无明显影响。

Objective To evaluate the effects of a single general anesthesia on neurodevelopment in preschool children.Methods American Society of Anesthesiologists physical statusⅠ-Ⅱchildren of either sex,aged 3-6 yr,who were undergoing dental treatment under general anesthesia or non-general anesthesia,were enrolled in the study.Children in general anesthesia group received dental treatment under general anesthesia,while children in control group received pit and fissure sealant.In general anesthesia group,the children entered the operating room accompanied by their parents and inhaled 50%nitrous oxide and 8%sevoflurane,propofol 2 mg/kg,fentanyl 2μg/kg,and cisatracurium 0.1 mg/kg and dexamethasone 0.2 mg/kg were intravenously injected,mechanical ventilation was performed after nasotracheal intubation under the guidance of a video laryngoscope,and anesthesia was maintained through inhalation of 2.5%-3.0%sevoflurane.The outcomes of neurodevelopment were assessed and scored using Wechsler Preschool and Primary Scale of Intelligence,Behavior Rating Inventory of Executive Function,and Adaptive Behavior Assessment System.Results Forty-four children were included in general anesthesia group and 19 children in non-general anesthesia group.There were no significant differences between the two groups in the changes in the scores of Wechsler Preschool and Primary Scale of Intelligence,Behavior Rating Inventory of Executive Function,and Adaptive Behavior Assessment System before anesthesia and at 6 months after operation(P>0.05).Conclusions A single general anesthesia exerts no significant effect on neurodevelopment in preschool children.