孕期母体麻醉暴露对妊娠结局及子代神经发育的影响

Effects of maternal anesthesia exposure during pregnancy on pregnancy outcome and neurodevelopment of offspring

随着医疗技术的提高,孕期因为手术需要接受麻醉的患者日益增多,孕期麻醉暴露对子代神经发育的影响也逐渐受到广大医务工作者的关注。目前对于麻醉药物神经毒性的探索,大多来自啮齿动物和非人类灵长动物的临床前研究。而这些动物研究与之前的人类回顾性队列研究数据存在一定的差异,且这一领域的人类研究有限,目前尚无定论。2016年美国食品与药品管理局(FDA)发布了一项关于妊娠晚期和婴幼儿接触某些麻醉药物后认知功能受损的警告,并建议医务人员应平衡婴幼儿和孕妇麻醉的益处与潜在风险。然而,孕妇在妊娠任何时期均有可能暴露于麻醉药物。因此,本文总结了孕早(<14周)、中(14~27周)、晚(≥28周)三个不同时期孕妇暴露于全身麻醉,对子代神经发育和认知功能的影响。

With the improvement of medical technology,an increasing number of women need to receive anesthesia during pregnancy because of surgery,and medical workers gradually pay attention to the impact of anesthesia exposure during pregnancy on the neurodevelopment of offspring.Much of exploration of the neurotoxicity of anesthetics comes from preclinical studies in rodents and nonhuman primates,which are different from the data of these animal studies and previous retrospective cohort studies in humans.Human studies in this field are limited and currently inconclusive.In 2016,the United States Food and Drug Administration issued a warning regarding impaired brain development after exposure to certain anesthetic agents used for general anesthesia in the third trimester of pregnancy.Furthermore,it is also recommended that healthcare professionals balance the benefits and potential risks of anesthesia in infants and pregnant women.However,women may be exposed to narcotic drugs at any stage of pregnancy.Therefore,this paper summarizes the effects of maternal exposure to general anesthesia during early(<14 weeks),mid(14-27 weeks),and late pregnancy(≥28 weeks)on the neurodevelopment and cognitive function of their offspring.