全麻手术对婴幼儿智力的影响

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孩子都是父母的宝贝，孩子生病了，一家人都很心疼，特别有的需要手术，看着哭泣的宝贝，父母的眼睛👀中也噙满了泪水。家长除了心疼宝贝受着病痛的折磨，也担心麻醉对智力的影响，毕竟婴幼儿时期是大脑发育的黄金期。到目前为止，这方面还没有确切的结论，麻醉对大脑的发育是否产生不良后果还存在争议。这篇发表在Pediatr Res. 的文章Surgery requiring general anesthesia in preterm infants is associated with altered brain volumes at term equivalent age and neurodevelopmental impairment考察了全麻手术对早产儿大脑发育的影响，其结果如何呢？

摘要译文

早产儿接受全麻手术与足月同等年龄时脑容量改变和神经发育障碍有关

背景：

本研究的目的是描述和对比在足月同等年龄（TEA）前接受全麻手术对早早产儿的大脑发育和预后的影响。

方法：

对妊娠小于30周的早产儿进行研究，其中25例（n=25）在早产儿期进行了需要全身麻醉的手术，而59例（n=59）未接受全麻手术。在TEA时，对婴儿进行MRI扫描，测量脑组织体积、皮质表面积、回旋指数和白质微结构。用第三版婴儿和幼儿发展的Bayley量表在矫正年龄2岁时对其神经发育进行随访。采用校正临床和社会风险因素的多变量模型进行组间比较。

结果：

在校正临床和社会变量后，接受全麻手术的早产儿在TEA时的相对白质体积减少，在2年随访时的认知和运动综合评分降低。麻醉手术暴露时间越长，2岁时白质体积减少越大，认知和运动能力降低越多。

结论：

在早产儿期需要手术的极早产婴儿在TEA时白质体积较低，在2岁时神经发育结果较差。

影响：

对于极早产的婴儿，早产期间需要全身麻醉的手术与TEA时MRI上白质体积减少和2岁时认知和运动综合评分降低之间存在关联。众所周知，极早产婴儿的大脑在相应的第三个妊娠期内经历了快速增长。当前研究提示在这段时间接受全麻手术与更糟糕的结果之间存在关联。

原文摘要

Surgery requiring general anesthesia in preterm infants is associated with altered brain volumes at term equivalent age and neurodevelopmental impairment

Background: The aim of the study was to describe and contrast the brain development and outcome among very preterm infants that were and were not exposed to surgery requiring general anesthesia prior to term equivalent age (TEA).

Methods: Preterm infants born ≤30 weeks' gestation who did (n = 25) and did not (n = 59) have surgery requiring general anesthesia during the preterm period were studied. At TEA, infants had MRI scans performed with measures of brain tissue volumes, cortical surface area, Gyrification Index, and white matter microstructure. Neurodevelopmental follow-up with the Bayley Scales of Infant and Toddler Development, Third Edition was undertaken at 2 years of corrected age. Multivariate models, adjusted for clinical and social risk factors, were used to compare the groups.

Results: After controlling for clinical and social variables, preterm infants exposed to surgical anesthesia demonstrated decreased relative white matter volumes at TEA and lower cognitive and motor composite scores at 2-year follow-up. Those with longer surgical exposure demonstrated the greatest decrease in white matter volumes and lower cognitive and motor outcomes at age 2 years.

Conclusions: Very preterm infants who required surgery during the preterm period had lower white mater volumes at TEA and worse neurodevelopmental outcome at age 2 years.

Impact: In very preterm infants, there is an association between surgery requiring general anesthesia during the preterm period and reduced white mater volume on MRI at TEA and lower cognitive and motor composite scores at age 2 years.It is known that the very preterm infant's brain undergoes rapid growth during the period corresponding to the third trimester.The current study suggests an association between surgery requiring general anesthesia during this period and worse outcomes.

原始文献

Walsh BH, Paul RA, Inder TE, Shimony JS, Smyser CD, Rogers CE. Surgery requiring general anesthesia in preterm infants is associated with altered brain volumes at term equivalent age and neurodevelopmental impairment [published online ahead of print, 2020 Jun 23]. Pediatr Res. 2020;10.1038/s41390-020-1030-3. doi:10.1038/s41390-020-1030-3

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