经历手术和麻醉的儿童其年龄与精神疾病诊断的关系
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Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis.
的
当处于脑发育特殊年龄阶段的动物暴露于麻醉药物中将致其神经毒性，而相应的神经发育改变将在该动物成年期观察到。而有关儿童受麻醉药物致神经毒性影响最大的年龄阶段尚不清楚。
方 法
本研究是一项观察性的队列研究，通过分析1991-2010年期间德克萨斯州和纽约的个体医疗索赔事件构建的纵向数据集完成。本数据集用于评价≤5岁的患儿一次普通外科手术（幽门肌切开术，腹股沟疝，围产期后的包皮环切手术，扁桃体切除术/腺样体切除术）的麻醉时间是否会增加患儿随后精神疾病或某些方面发育迟缓（如阅读障碍，语言障碍）以及注意力缺陷多动症（ADHD）的发生风险。经历手术和麻醉的患儿以11个不同年龄阶段进行分类如下：≤28天，＞28天-≤6个月，＞6个月-1岁，其中大于1岁-≤5岁患儿以每间隔6个月划分一个等级。匹配患儿和健康儿童的一般资料情况和临床协变量后，采取1:5比例（1个经历手术和麻醉的患儿:5个一般儿童）进行患儿倾向分数评分。并采用Cox比例风险模型评估患儿精神疾病的发生与经历手术和麻醉关系的风险比。
结 果
本研究是一项观察性的队列研究，通过分析1991-2010年期间德克萨斯州和纽约的个体医疗索赔事件构建的纵向数据集完成。本数据集用于评价≤5岁的患儿一次普通外科手术（幽门肌切开术，腹股沟疝，围产期后的包皮环切手术，扁桃体切除术/腺样体切除术）的麻醉时间是否会增加患儿随后精神疾病或某些方面发育迟缓（如阅读障碍，语言障碍）以及注意力缺陷多动症（ADHD）的发生风险。经历手术和麻醉的患儿以11个不同年龄阶段进行分类如下：≤28天，＞28天-≤6个月，＞6个月-1岁，其中大于1岁-≤5岁患儿以每间隔6个月划分一个等级。匹配患儿和健康儿童的一般资料情况和临床协变量后，采取1:5比例（1个经历手术和麻醉的患儿:5个一般儿童）进行患儿倾向分数评分。并采用Cox比例风险模型评估患儿精神疾病的发生与经历手术和麻醉关系的风险比。
结 论
年龄低于5岁的小孩接受需要麻醉的小手术能轻度增加其精神疾病和发育迟缓以及ADHD的发生风险，但手术时长并不影响该风险。本研究的结果表明，延长小孩接受小手术的时间并不能减少麻醉引起的远期神经发育风险。为评估患儿年龄在接受手术和麻醉后引起的远期神经发育风险中的作用，研究纳入的手术类型需要进行甄别，因为某些手术可能能引起特定并发症所以该类手术只能在特定的年龄阶段进行。
原始文献摘要
Ing C, Sun M, Olfson M, et al. Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis.[J]. Anesthesia and analgesia,
Abstract：
BACKGROUND: Animals exposed to anesthetics during specific age periods of brain development experience neurotoxicity, with neurodevelopmental changes subsequently observed during adulthood. The corresponding vulnerable age in children, however, is unknown.
METHODS: An observational cohort study was performed using a longitudinal dataset constructed by linking individual-level Medicaid claims from Texas and New York from 1999 to 2010. This dataset was evaluated to determine whether the timing of exposure to anesthesia </=5 years of age for a single common procedure (pyloromyotomy, inguinal hernia, circumcision outside the perinatal period, or tonsillectomy and/or adenoidectomy) is associated with increased subsequent risk of diagnoses for any mental disorder, or specifically developmental delay (DD) such as reading and language disorders, and attention deficit hyperactivity disorder (ADHD). Exposure to anesthesia and surgery was evaluated in 11 separate age at exposure categories: </=28 days old, >28 days and </=6 months, >6 months and </=1 year, and 6-month age intervals between >1 year old and </=5 years old. For each exposed child, 5 children matched on propensity score calculated using sociodemographic and clinical covariates were selected for comparison. Cox proportional hazards models were used to measure the hazard ratio of a mental disorder diagnosis associated with exposure to surgery and anesthesia.
RESULTS: A total of 38,493 children with a single exposure and 192,465 propensity score-matched children unexposed before 5 years of age were included in the analysis. Increased risk of mental disorder diagnosis was observed at all ages at exposure with an overall hazard ratio of 1.26 (95% confidence interval [CI], 1.22-1.30), which did not vary significantly with the timing of exposure. Analysis of DD and ADHD showed similar results, with elevated hazard ratios distributed evenly across all ages, and overall hazard ratios of 1.26 (95% CI, 1.20-1.32) for DD and 1.31 (95% CI, 1.25-1.37) for ADHD.
CONCLUSIONS: Children who undergo minor surgery requiring anesthesia under age 5 have a small but statistically significant increased risk of mental disorder diagnoses and DD and ADHD diagnoses, but the timing of the surgical procedure does not alter the elevated risks. Based on these findings, there is little support for the concept of delaying a minor procedure to reduce long-term neurodevelopmental risks of anesthesia in children. In evaluating the influence of age at exposure, the types of procedures included may need to be considered, as some procedures are associated with specific comorbid conditions and are only performed at certain ages.
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