【摘要】：目的:探討新生兒心臟手術的圍手術期麻醉暴露與1歲時的神經(jīng)發(fā)育結果的相關性。方法:選取四川省人民醫(yī)院行心臟手術的新生兒115例,納入隊列研究,于術前和術后7 d行大腦磁共振(MRI),記錄圍手術期揮發(fā)性麻醉藥、苯二氮卓類與阿片類藥物使用情況,患兒1歲時應用貝利嬰幼兒發(fā)展量表評估患兒的認知、語言和運動情況,在矯正其他協(xié)變量基礎上分析它們的相關性。結果:共有92例患兒被納入研究,患兒1歲時貝利嬰幼兒發(fā)展量表認知、語言和運動的分值分別為104.2±14.7,85.6±11.3和86.9±13.5;術前MRI顯示顱腦損傷17例,術后MRI顯示顱腦損傷25例。多重線性回歸分析顯示與1歲神經(jīng)發(fā)育結果相關的因素包括MRI顯示術后腦損傷、揮發(fā)性麻醉藥的最低肺泡有效濃度、芬太尼總質量濃度、苯二氮卓類總質量濃度、ICU住院時間、術前平均區(qū)域腦氧飽和度和染色體異常。結論:揮發(fā)性麻醉藥暴露、術后MRI顯示腦損傷以及長ICU住院時間是患兒1歲時神經(jīng)發(fā)育預后差的影響因素。需要采取針對性的措施,降低圍手術期致神經(jīng)損傷的危險因素。
[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 鹵14.7 鹵85.6 鹵11.3 and 86.9 鹵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.
【作者單位】： 四川省醫(yī)學科學院·四川省人民醫(yī)院麻醉科;
【分類號】：R726.5

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