妊娠期全麻对胎儿神经认知发育影响的系统评价及Meta分析

2021
08/23

+
分享
评论
米勒之声
A-
A+

美国食品和药物管理局警告中提出,孕妇暴露在全身麻醉剂中可能会损害胎儿的大脑发育。这篇综述系统地评估了这一警告背后的证据。


本文由“罂粟花”授权转载


 

妊娠期全麻对胎儿神经认知发育影响的系统评价及Meta分析


 

贵州医科大学 高鸿教授课题组

翻译:牛振瑛  编辑:佟睿  审校:曹莹

 

背景

美国食品和药物管理局警告中提出,孕妇暴露在全身麻醉剂中可能会损害胎儿的大脑发育。这篇综述系统地评估了这一警告背后的证据。

方法

检索PubMed、EMBASE和Web of Science从建库到2020年4月3日的所有文献。临床前和临床研究均符合纳入标准。排除标准包括病例报告、体外模型、慢性暴露和仅在分娩期间暴露的研究。本综述对标准化平均数差异进行了Meta分析。主要观察指标是对学习/记忆的总体影响。次要观察指标包括神经元损伤的标记物(凋亡、突触形成、神经元密度和增殖)和亚组分析。

结果

共纳入65项临床前实验研究,未发现临床研究。孕期麻醉会损害学习和记忆(标准化均值差-1.16,95%可信区间-1.46~-0.85),并导致所有实验模型的神经元损伤,但与麻醉药物和孕期无关。在大多数研究中,偏倚的风险很高。尽管它们的大脑发育与人类有很大的不同,啮齿动物仍是最常用的动物物种。在少数研究中,未区分麻醉与手术的影响。在许多研究中,生理稳态的监测和严格控制均低于临床前和临床标准。暴露的时间和频率以及麻醉剂量往往比临床常规高得多。

结论

在临床前研究中,麻醉可引起孕期神经毒性的结论是一致的,但将这些结果转化为临床情况仍受到几个因素的限制。需要进一步的临床观察研究。

原始文献来源

Bleeser T, et al.Effects of general anaesthesia during pregnancy on neurocognitive development of the fetus: a systematic review and meta-analysis [J].Br J Anaesth. 2021 Jun;126(6):1128-1140.  doi: 10.1016/j.bja.2021.02.026.

 

Effects of general anaesthesia during pregnancy on neurocognitive development of the fetus: a systematic review and meta-analysis

Background: The US Food and Drug Administration warned that exposure of pregnant women to general anaesthetics may impair fetal brain development. This review systematically evaluates the evidence underlying this warning.


Methods: PubMed, EMBASE, and Web of Science were searched from inception until April 3, 2020. Preclinical and clinical studies were eligible. Exclusion criteria included case reports, in vitro models, chronic exposures, and exposure only during delivery. Meta-analyses were performed on standardised mean differences. The primary outcome was overall effect on learning/memory. Secondary outcomes included markers of neuronal injury (apoptosis, synapse formation,neurone density, and proliferation) and subgroup analyses.


Results: There were 65 preclinical studies included, whereas no clinical studies could be identified. Anaesthesia during pregnancy impaired learning and memory (standardised mean difference -1.16, 95% confidence interval -1.46 to -0.85) and resulted in neuronal injury in all experimental models, irrespective of the anaesthetic drugs and timing in pregnancy. Risk of bias was high in most studies. Rodents were the most frequently used animal species, although their brain development differs significantly from that in humans. In a minority of studies, anaesthesia was combined with surgery. Monitoring and strict control of physiological homeostasis were below preclinical and clinical standards in many studies. The duration and frequency of exposure and anaesthetic doses were often much higher than in clinical routine.


Conclusion:Anaesthesia-induced neurotoxicity during pregnancy is a consistent finding in preclinical studies, but translation of these results to the clinical situation is limited by several factors. Clinical observational studies are needed.



 
END


编辑:MiLu.米鹭

校对:Michel.米萱


不感兴趣

看过了

取消

本文由“健康号”用户上传、授权发布,以上内容(含文字、图片、视频)不代表健康界立场。“健康号”系信息发布平台,仅提供信息存储服务,如有转载、侵权等任何问题,请联系健康界(jkh@hmkx.cn)处理。
关键词:
Meta,妊娠期,神经元,全麻,胎儿,神经,观察,孕期

人点赞

收藏

人收藏

打赏

打赏

不感兴趣

看过了

取消

我有话说

0条评论

0/500

评论字数超出限制

表情
评论

为你推荐

推荐课程


社群

  • 第九季擂台赛官方群 加入
  • 手术室精益管理联盟 加入
  • 健康界VIP专属优惠 加入
  • 健康界药学专业社群 加入
  • 医健企业伴飞计划 加入

精彩视频

您的申请提交成功

确定 取消
5秒后自动关闭

您已认证成功

您已认证成功,可享专属会员优惠,买1年送3个月!
开通会员,资料、课程、直播、报告等海量内容免费看!

忽略 去看看
×

打赏金额

认可我就打赏我~

1元 5元 10元 20元 50元 其它

打赏

打赏作者

认可我就打赏我~

×

扫描二维码

立即打赏给Ta吧!

温馨提示:仅支持微信支付!

已收到您的咨询诉求 我们会尽快联系您

添加微信客服 快速领取解决方案 您还可以去留言您想解决的问题
去留言
立即提交