Hansen Tom G, Pedersen Jacob K, Henneberg Steen W, Morton Neil S, Christensen Kaare
Department of Anesthesia and Intensive Care, Odense University Hospital, Odense C, Denmark; Clinical Institute - Anesthesiology, University of Southern Denmark, Odense C, Denmark.
Paediatr Anaesth. 2015 Feb;25(2):186-92. doi: 10.1111/pan.12533. Epub 2014 Sep 24.
Few human cohort studies on anesthesia-related neurotoxicity and the developing brain have focused on and compared specific surgeries and conditions. These studies cannot disentangle the effects of anesthesia from those of the surgery and underlying conditions. This study aimed at assessing the impact of specific neurosurgical conditions and procedures in infancy on mortality and academic achievements in adolescence.
A nationwide unselected register-based follow-up study of the Danish birth cohorts 1986-1990 compared academic performances of all children having undergone neurosurgeries as infants with a randomly selected, age-matched 5% sample of the same cohorts. The two groups were compared regarding mortality prior to June 1st, 2006, average test scores at ninth grade, and finally the proportion of children not attaining test scores.
The exposure group comprised 228 and the control group 14 698 individuals. Hydrocephalus (n = 130), craniotomy (n = 43), and myelomeningocele/encephalocele children (n = 55) had a higher mortality (18.5.0%, 18.6%, and 7.3%, respectively) vs controls (1.3%; P < 0.00001, P < 0.00001, and P = 0.0052, respectively). Average test scores were significantly lower than controls in hydrocephalus and craniotomy (P = 0.0043 and P = 0.0077) but not myelomeningocele/encephalocele children (P = 0.2785); the proportion of available test scores were significantly lower in all three groups (40.8%, 60.0%, and 67.3%, respectively) vs 86.8% in controls (P < 0.00001, P = 0.000077, and P = 0.000064).
Neurosurgery in infancy was associated with high mortality and significantly impaired academic achievements in adolescence. When studying anesthesia-related neurotoxicity and the developing brain, focus on specific surgeries/conditions is important. Pooling of major/minor conditions and major/minor surgeries should be avoided.
很少有关于麻醉相关神经毒性与发育中大脑的人类队列研究聚焦并比较特定的手术和病症。这些研究无法区分麻醉的影响与手术及潜在病症的影响。本研究旨在评估婴儿期特定神经外科病症和手术对青少年死亡率和学业成绩的影响。
一项基于丹麦1986 - 1990年出生队列登记的全国性非选择性随访研究，比较了所有婴儿期接受过神经外科手术的儿童与从同一队列中随机抽取的年龄匹配的5%样本儿童的学业表现。比较了两组在2006年6月1日前的死亡率、九年级平均考试成绩，以及最终未达到考试成绩的儿童比例。
暴露组有228人，对照组有14698人。脑积水患儿（n = 130）、开颅手术患儿（n = 43）和脊髓脊膜膨出/脑膨出患儿（n = 55）的死亡率较高（分别为18.5%、18.6%和7.3%），而对照组为1.3%（P分别<0.00001、<0.00001和 = 0.0052）。脑积水和开颅手术患儿的平均考试成绩显著低于对照组（P = 0.0043和P = 0.0077），但脊髓脊膜膨出/脑膨出患儿并非如此（P = 0.2785）；三组中可获得考试成绩的比例均显著低于对照组（分别为40.8%、60.0%和67.3%），而对照组为86.8%（P<0.00001、P = 0.000077和P = 0.000064）。
婴儿期神经外科手术与高死亡率及青少年学业成绩显著受损相关。在研究麻醉相关神经毒性与发育中大脑时，关注特定手术/病症很重要。应避免将主要/次要病症及主要/次要手术合并在一起。
