Rugytė Danguolė, Širvinskienė Giedrė, Kregždytė Rima
Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Department of Health Psychology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Children (Basel). 2021 May 20;8(5):423. doi: 10.3390/children8050423.
Studies report the link between exposure to major neonatal surgery and the risk of later neurodevelopmental disorders. The aim of this study was to find out the behavioral problem scores of 2.5-5 years old children who had undergone median/major non-cardiac surgery before the age of 90 days, and to relate these to intraoperative cerebral tissue oxygenation values (rSO), perioperative duration of mechanical ventilation (DMV) and doses of sedative/analgesic agents. Internalizing (IP) and externalizing problems (EP) of 34 children were assessed using the CBCL for ages 1½-5. Median (range) IP and EP scores were 8.5 (2-42) and 15.5 (5-33), respectively and did not correlate with intraoperative rSO. DMV correlated and was predictive for EP (β (95% CI) 0.095 (0.043; 0.148)). An aggregate variable "opioid dose per days of ventilation" was predictive for EP after adjusting for patients' gestational age and age at the day of psychological assessment, after further adjustment for age at the day of surgery and for cumulative dose of benzodiazepines (β (95% CI 0.009 (0.003; 0.014) and 0.008 (0.002; 0.014), respectively). Neonatal/infantile intraoperative cerebral oxygenation was not associated with later behavioral problems. The risk factors for externalizing problems appeared to be similar to the risk factors in preterm infant population.
研究报告了新生儿接受重大手术与后期神经发育障碍风险之间的联系。本研究的目的是了解90天龄前接受中位/重大非心脏手术的2.5至5岁儿童的行为问题得分，并将这些得分与术中脑组织氧合值（rSO）、围手术期机械通气持续时间（DMV）以及镇静/镇痛药物剂量相关联。使用适用于1.5至5岁儿童的儿童行为量表（CBCL）评估了34名儿童的内化问题（IP）和外化问题（EP）。IP和EP得分的中位数（范围）分别为8.5（2 - 42）和15.5（5 - 33），且与术中rSO无相关性。DMV与之相关且可预测EP（β（95%置信区间）0.095（0.043；0.148））。在对患者的胎龄和心理评估当天的年龄进行调整后，以及在进一步对手术当天的年龄和苯二氮䓬类药物的累积剂量进行调整后，一个综合变量“每通气天数的阿片类药物剂量”可预测EP（β（95%置信区间）分别为0.009（0.003；0.014）和0.008（0.002；0.014））。新生儿/婴儿期术中脑氧合与后期行为问题无关。外化问题的风险因素似乎与早产儿群体中的风险因素相似。
