新生儿心脏手术的围手术期麻醉暴露与1岁神经发育状况的关系

发布时间：2018-07-15 08:33

【摘要】：目的:探讨新生儿心脏手术的围手术期麻醉暴露与1岁时的神经发育结果的相关性。方法:选取四川省人民医院行心脏手术的新生儿115例,纳入队列研究,于术前和术后7 d行大脑磁共振(MRI),记录围手术期挥发性麻醉药、苯二氮卓类与阿片类药物使用情况,患儿1岁时应用贝利婴幼儿发展量表评估患儿的认知、语言和运动情况,在矫正其他协变量基础上分析它们的相关性。结果:共有92例患儿被纳入研究,患儿1岁时贝利婴幼儿发展量表认知、语言和运动的分值分别为104.2±14.7,85.6±11.3和86.9±13.5;术前MRI显示颅脑损伤17例,术后MRI显示颅脑损伤25例。多重线性回归分析显示与1岁神经发育结果相关的因素包括MRI显示术后脑损伤、挥发性麻醉药的最低肺泡有效浓度、芬太尼总质量浓度、苯二氮卓类总质量浓度、ICU住院时间、术前平均区域脑氧饱和度和染色体异常。结论:挥发性麻醉药暴露、术后MRI显示脑损伤以及长ICU住院时间是患儿1岁时神经发育预后差的影响因素。需要采取针对性的措施,降低围手术期致神经损伤的危险因素。
[Abstract]:Objective: to investigate the relationship between perioperative anesthetic exposure and neurodevelopmental outcome in neonatal cardiac surgery. Methods: 115 neonates undergoing cardiac surgery in Sichuan Provincial people's Hospital were enrolled in the cohort study. Brain MRI was performed before and 7 days after operation. The use of volatile anesthetics, benzodiazepines and opioids during perioperative period was recorded. The cognitive, language and motor status of the children were evaluated by the Bailey Infant Development scale at the age of 1, and the correlation between them was analyzed on the basis of correcting other covariables. Results: a total of 92 children were included in the study. The scores of cognition, language and movement were 104.2 卤14.7 卤85.6 卤11.3 and 86.9 卤13.5respectively at the age of 1 year old, 17 cases showed craniocerebral injury before operation and 25 cases showed craniocerebral injury on post-operative MRI. Multiple linear regression analysis showed that the factors associated with 1 year old neurodevelopmental outcome included brain injury after MRI, minimum alveolar effective concentration of volatile anesthetics, total mass concentration of fentanyl, total mass concentration of benzodiazepines and duration of ICU stay. Preoperative mean regional cerebral oxygen saturation and chromosomal abnormalities. Conclusion: exposure to volatile anesthetics, brain injury after operation and long stay in ICU are the influencing factors for poor prognosis of nerve development in children aged 1 years. Appropriate measures should be taken to reduce the risk factors of perioperative nerve injury.
【作者单位】：四川省医学科学院·四川省人民医院麻醉科;
【分类号】：R726.5

【共引文献】