幼儿手术全麻暴露与学习和行为结局的关系：基于人群的出生队列研究
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Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort.
背景与目的
幼小动物全麻暴露会导致神经退行性变和长期的行为异常，这些现象是否发生于儿童仍未可知。本研究基于人群出生队列来研究这一假设，即在3岁前多次暴露于手术全麻与不良的神经发育结局相关。
方 法
本回顾性研究人群来自于1996年至2000年（含）明尼苏达州奥姆斯特德县出生的儿童。倾向匹配选择3岁以前暴露与未暴露于全身麻醉的儿童。通过医疗记录和学校记录获得结局资料，包括学习障碍，注意力缺陷/多动障碍以及组应用能力以及成绩测试。分析方法用比例风险回归模型和混合线性模型。
结 果
对116例全麻多次暴露，457例单次暴露和463例未暴露儿童进行分析，多次暴露（非单次）与学习障碍和注意力缺陷/多动障碍有关（与未暴露组比较，学习障碍风险比： 2.17 [95 ％CI，1.32〜3.59]）。多次暴露与认知能力和学习成绩的下降有关。单次暴露与阅读和语言成绩的轻度下降相关，但与认知能力无关。
结 论
这些对于全麻过的儿童的研究证实了那些在年长儿人群中的发现，并提供了额外的证据，即多次全麻暴露的儿童更可能出现与学习和注意力有关的不良结局，其虽然存在明显的相关性，但是这些数据并不能明确是麻醉的原因。
原始文献摘要
Hu D, Flick RP, Zaccariello MJ, et al.Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort[J]. Anesthesiology, 2017. [Epub ahead of print] doi: 10.1097/ALN.0000000000001735.
BACKGROUND:Exposure of young animals to general anesthesia causes neurodegeneration and lasting behavioral abnormalities; whether these findings translate to children remains unclear. This study used a population-based birth cohort to test the hypothesis that multiple, but not single, exposures to procedures requiring general anesthesia before age 3 yr are associated with adverse neurodevelopmental outcomes.
METHODS: A retrospective study cohort was assembled from children born in Olmsted County, Minnesota, from 1996 to 2000 (inclusive). Propensity matching selected children exposed and not exposed to general anesthesia before age 3 yr. Outcomes ascertained via medical and school records included learning disabilities, attention-deficit/hyperactivity disorder, and group-administered ability and achievement tests. Analysis methods included proportional hazard regression models and mixed linear models.
RESULTS: For the 116 multiply exposed, 457 singly exposed, and 463 unexposed children analyzed, multiple, but not single, exposures were associated with an increased frequency of both learning disabilities and attention-deficit/hyperactivity disorder (hazard ratio for learning disabilities = 2.17 [95% CI, 1.32 to 3.59], unexposed as reference). Multiple exposures were associated with decreases in both cognitive ability and academic achievement. Single exposures were associated with modest decreases in reading and language achievement but not cognitive ability.
CONCLUSIONS: These findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention. Although a robust association was observed, these data do not determine whether anesthesia per se is causal.
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