全身麻醉对婴幼儿大脑发育影响的临床研究

Clinical study on the effect of general anesthesia on brain development of infants

目的探讨全身麻醉对婴幼儿术后大脑发育的影响。方法对2012—2015年期间年龄为0~3岁时在广西医科大学第一附属医院接受全身麻醉下的手术治疗儿童(研究组)共429例在其3~6岁时进行回顾性分析。按照研究组儿童生活的城市地区、年龄、性别、民族等特征采取1∶1配对设计,选取0~3岁期间未接受过全身麻醉的3~6岁儿童共429例作为对照。查阅和记录研究组儿童的麻醉记录单及基本信息,将研究组儿童按麻醉时长分为三组:<1 h组(A1组)、1~2 h组(A2组)、>2 h组(A3组),按手术麻醉次数分为两组:单次组(B1组)、2次组(B2组),按苏醒时间分为三组:<30 min组(C1组)、30~60 min组(C2组)、>60 min组(C3组)。采用韦氏幼儿智力量表第四版(WPPSI-IV)综合评估上述儿童的总体认知能力及智力活动水平,Achenbach儿童行为量表(CBCL)总得分评估儿童行为、情绪和社会能力,盖塞尔发展量表(Gesell)评价儿童的中枢神经系统功能及发育水平。结果适用2岁6个月~4岁前韦氏智力量表的儿童中:与对照组比较,研究组儿童的工作记忆指数得分降低;适用4岁~6岁11个月韦氏智力量表的儿童中:与对照组比较,研究组儿童的言语理解指数、流体推理指数、加工速度指数、工作记忆指数得分和盖塞尔量表的发育商数降低(P<0.05)。与麻醉时长A1组、A2组比较,A3组的总智商、工作记忆指数得分降低(P<0.05);与手术麻醉次数B1组比较,B2组的总智商、工作记忆指数、发育商数得分降低(P<0.05);各组间苏醒时间比较,差异无统计学意义(P>0.05)。结论婴幼儿在大脑发育期接受全身麻醉可能对其神经系统发育产生影响,接受2次或时长大于2 h全身麻醉的婴幼儿在智力发育的过程中的短时记忆和存储、加工以及输出信息的能力更易受影响。

Objective To investigate the effect of general anesthesia on postoperative brain development of infants.Methods A retrospective analysis was performed on 429 children aged 0–3 years(study group)who underwent surgical treatment under general anesthesia in the First Affiliated Hospital of Guangxi Medical University from 2012 to 2015 when they were 3–6 years old.According to the characteristics of urban areas,age,gender and ethnicity of children in the study group,a 1∶1 matching design was adopted.A total of 429 children aged 3–6 years who did not receive general anesthesia during the period of 0–3 years old were selected as controls.The anesthesia records and basic information of the children in the study group were reviewed and recorded.Children in the study group were divided into three groups according to the duration of anesthesia:<1 h group(A1 group),1–2 h group(A2 group),and>2 h group(A3 group),two groups according to the number of surgical anesthesia:1 time group(B1 group),2 times group(B2 group),and three groups according to recovery time:<30 min group(C1 group),30–60 min group(C2 group),and>60 min group(C3 group).The fourth edition of the Wechsler Preschool and Primary Scale of Intelligence(WPPSI-Ⅳ)was used to comprehensively evaluate the overall cognitive ability and intellectual activity level of the above children,the total score of the Achenbach Children's Behavior Scale(CBCL)was used to evaluate children's behaviors,emotions,and social abilities,while the Gesell Development Scale(Gesell)was used to evaluate children's central nervous system functions and developmental levels.Results Among the children aged 2 years and 6 months to 4 years old who were suitable for the WPPSI-Ⅳ:compared with the control group,the working memory index score of the children in the study group decreased;among the children aged 4 to 6 years and 11 months who were suitable for the WPPSI-Ⅳ:compared with the control group,the children in the study group showed a decrease in speech comprehension,fluid reasoning,processing speed,working memory index scores,and developmental quotient of the Gesell scale(P<0.05).Compared with the group A1 and the group A2,the scores of total intelligence quotient and working memory index in the group A3 decreased(P<0.05);compared with the group B1,the scores of total intelligence quotient,working memory index and developmental quotient in the group B2 decreased(P<0.05).There was no statistically significant difference in the recovery time between the groups(P>0.05).Conclusion Infants receiving general anesthesia during brain development may have an impact on their nervous system developments.Infants who receive general anesthesia twice or for a duration greater than 2 hours are more susceptible to short-term memory,storage,processing,and output of information during intellectual development.