單次短時七氟烷全身麻醉對0～3歲兒童術后早期智能發育的影響

黃夢朦，南克，韓園，邵玲笑，胡夢潔，南洋，姬斌，林函，李軍

（溫州醫科大學附屬第二醫院育英兒童醫院 麻醉與圍術期醫學科，浙江 溫州 325027）

單次短時七氟烷全身麻醉對0～3歲兒童術后早期智能發育的影響

黃夢朦，南克，韓園，邵玲笑，胡夢潔，南洋，姬斌，林函，李軍

（溫州醫科大學附屬第二醫院育英兒童醫院 麻醉與圍術期醫學科，浙江 溫州 325027）

目的：探討單次短時七氟烷全身麻醉對0～3歲兒童術后早期智能發育的影響。方法：采用Gesell發育量表對200例0～3歲兒童進行麻醉前1 d與麻醉后3個月發育情況的評測與對比；再分別選取與麻醉前1 d和麻醉后3個月同齡的正常兒童各200例為對照組I和對照組I I。結果：與麻醉前1 d相比較，麻醉后3個月兒童的4個能區發育齡均有不同程度提高（P＜0.001）；麻醉前后各能區的發育商數（DQ）差異均無統計學意義（P＞0.05）。與對照組同齡兒童比較，麻醉前1 d及麻醉后3個月各能區DQ差異均無統計學意義（P＞0.05）。結論：接受單次短時七氟烷全身麻醉對0～3歲兒童術后Gesell發育量表各指標沒有明顯影響，各能區隨著年齡發育均正常。

麻醉，全身；Gesell發育量表；智能發育

Abstract: Objective:To explore the effect of single short-term sevoflurane general anesthesia on early postoperative intelligence development in children aged 0-3 years.Methods:Gesell development scale was used to evaluate the neurological development (DQ) of 200 children aged 0 to 3 years old 1 day preoperatively and 3 months after operation. Another 200 normal children in the same age range were selected respectively as control group I and control group II which compared and contrasted with those in anesthesia group.Results:Compared with the DQ scores preoperative 1 day, the developmental age (motor, adaptive, verbal, social) of the four energy regions of children increased to varying degrees after 3 months of anesthesia (P＜0.001). The difference of DQ scores of four energy regions 1 day preoperatively and 3 months after operation was not statistically significant(P＞0.05). There was no significant difference in DQ scores of four energy regions between anesthesia group and control group (P＞0.05).Conclusion:A single short-term sevoflurane general anesthesia has no significant effect on the postoperative DQ of Gesell development scales in children aged 0-3 years, and all energy regions are normal development with age.

Key words:anesthesia, general; Gesell development schedule; intelligence development

以往我們認為常規的麻醉操作和平穩的術中管理不會引起與小兒麻醉相關的神經系統后遺癥。但近年來各種動物實驗研究顯示，發育中的大腦在關鍵時期接觸麻醉藥物可能會引發廣泛的神經元凋亡及神經退行性變，還可能導致遠期神經心理及行為發育的障礙[1]。美國FDA在2016年12月也發布警告：妊娠末3個月的孕婦或3歲以下兒童在術中重復或長時間（＞3 h）使用全麻藥和鎮靜藥，可能會影響胎兒及兒童的大腦發育[2]。……