麻醉是否影响大脑发育？最新的研究结果来了

本文由“小麻哥的日常”授权转载

摘要译文（供参考）  

麻醉和镇静暴露与接受先天性心脏病手术患儿的神经发育结果：

一项回顾性队列研究  

背景：  

与健康儿童相比，接受复杂心脏手术的儿童暴露于大量累积剂量的镇静药物和挥发性麻醉剂，并且更频繁地使用氯胺酮麻醉。我们假设，在这一人群中，更多地暴露于镇静和麻醉与18个月大时较低的神经发育评分有关。  

方法：  

我们对参与环境暴露和神经发育结果前瞻性观察研究的先天性心脏病婴儿进行了二次分析，以评估累积挥发性麻醉剂和镇静药物的影响。在18个月大时使用Bayley婴幼儿发育量表第三版（Bayley III）之前，收集暴露于挥发性麻醉剂以及所有手术室和重症监护室暴露于镇静和麻醉药物的累积最小肺泡浓度小时数。  

结果：  

研究队列包括41例（37%）单心室和69例（63%）双心室患者。  

挥发性麻醉剂、阿片类药物、苯二氮卓类药物和右美托咪定暴露与Bayley III评分异常无关。  

在18个月的随访中，在校正混杂因素后，氯胺酮暴露量每增加1mg/kg，Bayley III运动评分就会降低0.34分（95%CI:0.64，-0.05），P=0.024。  

结论：  

在接受各种影像学检查和手术的先天性心脏病婴儿中，挥发性麻醉剂的总累积暴露量与神经发育障碍无关，而氯胺酮剂量越高，运动能力越差。  

原文摘要  

Anesthesia and sedation exposure and neurodevelopmental outcomes in infants undergoing congenital cardiac surgery: a retrospective cohort study

Background: 

Children undergoing complex cardiac surgery are exposed to substantial cumulative doses of sedative medications and volatile anesthetics and are more frequently anesthetized with ketamine, compared with healthy children. We hypothesized that greater exposure to sedation and anesthesia in this population is associated with lower neurodevelopmental scores at 18-months of age.

Methods: 

We conducted a secondary analysis of infants with congenital heart disease who participated in a prospective observational study of environmental exposures and neurodevelopmental outcomes to assess the impact of cumulative volatile anesthetic agents and sedative medications. Cumulative minimum alveolar concentration hours of exposure to volatile anesthetic agents and all operating room and intensive care unit exposures to sedative and anesthesia medications were collected prior to administration of Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 18-months of age.

Results: 

The study cohort included 41 (37%) single-ventricle and 69 (63%) two-ventricle patients. Exposures to volatile anesthetic agents, opioids, benzodiazepines and dexmedetomidine were not associated with abnormal Bayley-III scores. At 18-month follow-up, after adjusting for confounders, each mg/kg increase in ketamine exposure was associated with a 0.34 (95%CI: -0.64, -0.05) point decrease in Bayley-III Motor scores, P = 0.024.

Conclusions: 

Total cumulative exposures to volatile anesthetic agents were not associated with neurodevelopmental impairment in infants with congenital heart disease undergoing various imaging studies and procedures, whereas higher ketamine doses were associated with poorer motor performance.

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭  

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