小兒麻醉對認(rèn)知的影響

CognitionandBrainStructure

FollowingEarlyChildhoodSurgery

WithAnesthesiaBaryniaBackeljauw

BS,CincinnatiChildren’sHospitalMedicalCenter

兒童期是敏感的神經(jīng)發(fā)育階段，由于麻醉藥能夠強烈的興奮或抑制神經(jīng)傳遞，因此麻醉藥能夠干擾神經(jīng)網(wǎng)絡(luò)發(fā)育，導(dǎo)致長期功能障礙。在動物幼體實驗中發(fā)現(xiàn)，麻醉后會出現(xiàn)神經(jīng)元缺失和長期的學(xué)習(xí)、記憶損傷等神經(jīng)認(rèn)知功能受損的情況前言由于小兒特殊的生理和心理特點，麻醉是否會對其腦功能有所影響、麻醉藥是否影響其發(fā)育等一直以來都是麻醉科、兒科和神經(jīng)科醫(yī)生普遍關(guān)注的問題。雖然進(jìn)行了大量的研究，許多問題尚未清楚。BackgroundAnestheticsinducewidespreadcelldeath,permanentneuronaldeletion,andabstractneurocognitiveimpairmentinimmatureanimals,raisingsubstantialconcernsaboutsimilareffectsoccurringinyoungchildren.BackgroundEpidemiologicstudieshavebeenunabletosufficientlyaddressthisconcern,inpartduetorelianceongroup-administeredachievementtests,inabilitytoassessbrainstructure,andlimitedcontrolforconfounders.MethodsWecomparedhealthyparticipantsofalanguagedevelopmentstudyatage5to18yearswhohadundergonesurgerywithanesthesiabefore4yearsofage(n=53)withunexposedpeers(n=53)whowerematchedforage,gender,handedness,andsocioeconomicstatus.NeurocognitiveassessmentsincludedtheOralandWrittenLanguageScalesandtheWechslerIntelligenceScales(WAIS)orWISC,asappropriateforage.BrainstructuralcomparisonswereconductedbyusingT1-weightedMRIscans.方法ResultsAveragetestscoreswerewithinpopulationnorms,regardlessofsurgicalhistory.However,comparedwithcontrolsubjects,previouslyexposedchildrenscoredsignificantlylowerinlisteningcomprehensionandperformanceIQ.智力聽力理解能力ResultsExposuredidnotleadtogrosseliminationofgraymatterinregionspreviouslyidentifiedasvulnerableinanimals.DecreasedperformanceIQandlanguagecomprehension,however,wereassociatedwithlowergraymatterdensityintheoccipitalcortexandcerebellum.ConclusionsThepresentfindingssuggestthatgeneralanesthesiaforasurgicalprocedureinearlychildhoodmaybeassociatedwithlong-termdiminutionoflanguageabilitiesandcognition,aswellasregionalvolumetricalterationsinbrainstructure.ConclusionsAlthoughcausationremainsunresolved,thesefindingsnonethelesswarrantadditionalresearchintothephenomenon’smechanismandmitigatingstrategies.為什么成年人和兒童早期接受麻醉后的影響差異很大？動物研究發(fā)現(xiàn)，未完全成熟的小腦神經(jīng)元易受麻醉藥物影響，而小腦結(jié)構(gòu)的損害可能與較低的IQ相關(guān)。討論動物實驗證明：全麻藥物可誘發(fā)神經(jīng)細(xì)胞凋亡，最終導(dǎo)致神經(jīng)系統(tǒng)功能損害動物研究發(fā)現(xiàn)，未完全成熟的小腦神經(jīng)元易受麻醉藥物影響，而小腦結(jié)構(gòu)的損害可能與較低的IQ相關(guān)。全麻藥觸發(fā)嚙齒類動物發(fā)育期大腦的神經(jīng)細(xì)胞凋亡，并致成年期的神經(jīng)功能缺陷，在人類發(fā)育期大腦全麻藥是否也能導(dǎo)致相似的神經(jīng)毒性？

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