CAJ | 학술논문

[目的]探讨婴幼儿时期接受全身麻醉与手术是否影响儿童远期的智力和感觉统合能力发育.[方法]采取1∶1匹配病例对照研究,选取0～3岁期间在全身麻醉下接受非神外非心外手术、入选本研究时实足年龄为6～8岁的北京城区儿童为麻醉组(n=81)；根据每例试验组儿童的性别、年龄、父母文化程度与职业、社会经济状况、教育背景等影响智力发育的主要因素作为匹配条件,选取0～3岁期间未经历过全身麻醉和手术的儿童为对照组(n=81).分别采用韦氏儿童智力量表第四版(中文版)、儿童感觉统合能力发展评定量表评估两组儿童的智力和感觉统合能力.[结果]在智力发育水平上麻醉组与对照组儿童相比在总智商(113.6±10.4vs.114.6±9.9,P=0.524)、言语理解指数(111.0±11.3vs.112.7±10.3,P=0.320)、知觉推理指数(113.4±12.1 vs.114.3±10.4,P=0.631)、工作记忆指数(109.6±13.6vs.109.4±10.1,P=0.896)、加工速度指数(105.9 ±9.7 vs.107.7±10.5,P=0.199)、一般能力指数(114.4±11.3vs.115.3±11.3,P=0.852)、认知效率指数(110.1±10.9vs.110.4±9.2,P=0.882)等方面差异均无统计学意义；在智力结构方面,工作记忆-言语理解指数差值具有临床差异的发生率在麻醉组高于对照组(7.4％ vs.0,P=0.038).两组儿童感觉统合能力失调的发生率无统计学差异(46.9％vs.45.7％,P=0.875),但麻醉组中经历两次麻醉者前庭失衡的发生率高于一次麻醉者(75.0％vs.20.8％,P=0.038).[结论]总体上婴幼儿期麻醉手术对儿童远期的智力和感觉统合能力发育无明显影响,但麻醉组儿童在智力结构方面工作记忆指数-言语理解指数差值出现临床差异的发生率增高.婴幼儿期接受两次麻醉手术者前庭失衡发生率增高.
[목적]탐토영유인시기접수전신마취여수술시부영향인동원기적지력화감각통합능력발육.[방법]채취1∶1필배병례대조연구,선취0～3세기간재전신마취하접수비신외비심외수술、입선본연구시실족년령위6～8세적북경성구인동위마취조(n=81)；근거매례시험조인동적성별、년령、부모문화정도여직업、사회경제상황、교육배경등영향지력발육적주요인소작위필배조건,선취0～3세기간미경력과전신마취화수술적인동위대조조(n=81).분별채용위씨인동지역량표제사판(중문판)、인동감각통합능력발전평정량표평고량조인동적지력화감각통합능력.[결과]재지력발육수평상마취조여대조조인동상비재총지상(113.6±10.4vs.114.6±9.9,P=0.524)、언어리해지수(111.0±11.3vs.112.7±10.3,P=0.320)、지각추리지수(113.4±12.1 vs.114.3±10.4,P=0.631)、공작기억지수(109.6±13.6vs.109.4±10.1,P=0.896)、가공속도지수(105.9 ±9.7 vs.107.7±10.5,P=0.199)、일반능력지수(114.4±11.3vs.115.3±11.3,P=0.852)、인지효솔지수(110.1±10.9vs.110.4±9.2,P=0.882)등방면차이균무통계학의의；재지력결구방면,공작기억-언어리해지수차치구유림상차이적발생솔재마취조고우대조조(7.4％ vs.0,P=0.038).량조인동감각통합능력실조적발생솔무통계학차이(46.9％vs.45.7％,P=0.875),단마취조중경력량차마취자전정실형적발생솔고우일차마취자(75.0％vs.20.8％,P=0.038).[결론]총체상영유인기마취수술대인동원기적지력화감각통합능력발육무명현영향,단마취조인동재지력결구방면공작기억지수-언어리해지수차치출현림상차이적발생솔증고.영유인기접수량차마취수술자전정실형발생솔증고.
[Objective]To investigate the long-term effects of early exposure to general anesthesia and surgery on children＇ s development of intelligence and sensory integration function.[Methods] This was a 1 ∶ 1matched case-control study.Children who lived in Beijing urban area,underwent non-cardiac/non-neurosurgical surgery under general anesthesia before 3 years of age,aged 6 to 8 years at the time of assessment were enrolled as anesthesia group.Children,who lived in the same area but did not undergo general anesthesia and surgery before 3years of age,were matched according to children＇s age,sex,educational level,as well as parents＇ educational background,occupation,socioeconomic status and enrolled in the control group.The Wechsler Intelligence Scale for Children-fourth edition( Chinese version)and the Child Sensory Integration Check List were used to evaluate the intelligence and sensory integration function of the two groups of children.Resnlts There were no significant differences between two groups with respect to full scale Intelligence Quotient( 113.6 ± 10.4 vs.114.6 ±9.9,P=0.524 ) as well as Verbal Comprehension Index( 111.0 ± 11.3 vs.112.7 ± 10.3,P=0.320),Perceptual Reasoning Index(113.4 ±12.1 vs.114.3 ±10.4,P=0.631),Working Memory Index(109.6 ± 13.6 vs.109.4 ±10.1,P=0.896),Processing Speed Index( 105.9 ± 9.7 vs.107.7 ± 10.5,P=0.199 ),General Ability Index ( 114.4 ± 11.3vs.115.3 ±11.3,P=0.852)and Cognitive Productive Index(110.1 ± 10.9 vs.110.4 ±9.2,P=0.882).In terms of intelligence structure,the incidence of clinically meaningful difference between indexes of Working Memory and Verbal Comprehension was significantly higher in the anesthesia group than in the control group(7.4％ vs.0,P=0.038 ).There was no significant difference in the incidence of sensory integration dysfunction between two groups (46.9％ vs.45.7％,P=0.875 ).However,among children in the anesthesia group,the incidence of vestibule balance dysfunction was significantly higher in those who had experienced two times anesthesia than those who had only single anesthesia exposure(75.0％ vs.20.8％,P=0.038).[Conclusions]In general,general anesthesia and surgery during the first three years of life have no significant long-term effects on children＇s development of intelligence and sensory integration function.However,the incidence of clinically meaningftl difference between indexes of Working Memory and Verbal Comprehension increased in the anesthesia group.Children who experienced two anesthesia exposures during the first three years of life have a higher incidence of vestibule balance dysfunction.