麻醉会让你变笨吗？

本文由“小麻哥的日常"授权转载

摘要译文（供参考）

儿童期接受全身麻醉与注意缺陷多动障碍和神经发育的关系

背景：

关于全身麻醉与儿童不良神经发育和行为障碍之间的关系，有不一致的报道。

方法：

这项全国性的队列研究包括2008年至2009年在韩国出生的儿童，并随访至2017年12月31日。

该队列包括93717名接受气管插管全身麻醉（ETI）的参与者，他们与未暴露的受试者以1:1的比例匹配。

全身麻醉是由国家健康保险局（National Health Insurance Service）的气管内麻醉治疗规范定义的，索引日期是第一次全身麻醉事件。

主要结果是注意力缺陷多动障碍（ADHD），它被定义为至少是72个月后国际疾病分类代码F90.X第10版的主要诊断。

使用发育筛查测试（韩国年龄和阶段问卷[K-ASQ]）评估神经发育，这是次要结果。

K-ASQ每年从1岁到6岁进行一次，由5个领域组成。

使用Cox风险模型估计全身麻醉与ADHD之间的关联，使用广义估计方程估计其与神经发育的关联，并在开始日期后1年内控制多个风险因素。

结果：

开始日期的中位年龄为3.8（95%置信区间[CI]，1.7-5.8）岁，男性57625例（61.5%）。

在5年的平均随访期内，暴露组和未暴露组的ADHD发病率分别为42.6和27.7/万人年（PY）（绝对比率差异14.9[95%可信区间，12.5-17.3]/万PY）。

与未暴露组相比，暴露组患ADHD的风险增加（调整后的风险比，1.41[95%可信区间，1.30-1.52]）。

此外，ETI麻醉持续时间较长和ETI全身麻醉程序较多与患ADHD风险较高相关。

ETI全身麻醉也与K-ASQ结果较差相关。

结论：

对儿童使用ETI全身麻醉与ADHD风险增加和神经发育筛查测试结果不佳相关。

关键词：

注意缺陷多动障碍；儿童全身麻醉；神经发育。

原文摘要

Association Between Receipt of General Anesthesia During Childhood and Attention Deficit Hyperactive Disorder and Neurodevelopment

Background: 

There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children.

Methods: 

This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months. Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date.

Results: 

The median age at the index date was 3.8 (95% confidence interval [CI], 1.7-5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5-17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30-1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ.

Conclusion: 

Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.

Keywords: 

Attention Deficit Hyperactive Disorder; Children; General Anesthesia; Neurodevelopment.

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