Yang Xiaoyu, Wu Yan, Xu Xuanxian, Gao Wenzong, Xie Juntao, Li Zuoqing, Zhou Xue, Feng Xia
Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.
Department of Pediatric Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.
J Pers Med. 2023 May 12;13(5):823. doi: 10.3390/jpm13050823.
(1) Background: Preclinical as well as population studies have connected general anesthesia and surgery with a higher risk of abnormal cognitive development, including emotional development. Gut microbiota dysbiosis in neonatal rodents during the perioperative period has been reported, however, the relevance of this to human children who undergo multiple anesthesia for surgeries is unknown. Given the emerging role of altered gut microbes in propagating anxiety and depression, we sought to study whether repeated infantile exposures to surgery and anesthesia affect gut microbiota and anxiety behaviors later in life. (2) Methods: This is a retrospectively matched cohort study comparing 22 pediatric patients of less than 3 years of age with multiple exposures (≥3) to anesthesia for surgeries and 22 healthy controls with no history of exposure to anesthesia. The parent report version of the Spence Children's Anxiety Scale (SCAS-P) was applied to evaluate anxiety in children aged between 6 and 9 years old. Additionally, the gut microbiota profiles of the two groups were compared using 16S rRNA gene sequencing. (3) Results: In behavioral tests, the p-SCAS score of obsessive compulsive disorder and social phobia were significantly higher in children with repeated anesthesia exposure relative to the controls. There were no significant differences between the two groups with respect to panic attacks and agoraphobia, separation anxiety disorder, physical injury fears, generalized anxiety disorder, and the total SCAS-P scores. In the control group, 3 children out of 22 were found to have moderately elevated scores, but none of them had abnormally elevated scores. In the multiple-exposure group, 5 children out of 22 obtained moderately elevated scores, while 2 scored as abnormally elevated. However, no statistically significant differences were detected in the number of children with elevated and abnormally elevated scores. The data show that repeated anesthesia and surgical exposures in children led to long-lasting severe gut microbiota dysbiosis. (4) Conclusions: In this preliminary study, our findings demonstrated that early repeated exposures to anesthesia and surgical predisposes children to anxiety as well as long-term gut microbiota dysbiosis. We should confirm these findings in a larger data population size and with detailed analysis. However, the authors cannot confirm an association between the dysbiosis and anxiety.
(1) 背景：临床前研究以及人群研究均已将全身麻醉和手术与认知发育异常（包括情绪发育异常）的较高风险联系起来。围手术期新生啮齿动物肠道微生物群失调已有报道，然而，这与接受多次手术麻醉的人类儿童的相关性尚不清楚。鉴于肠道微生物改变在引发焦虑和抑郁方面的新作用，我们试图研究婴儿期反复接受手术和麻醉是否会影响其日后生活中的肠道微生物群和焦虑行为。(2) 方法：这是一项回顾性匹配队列研究，比较了22名3岁以下接受多次（≥3次）手术麻醉的儿科患者和22名无麻醉暴露史的健康对照。采用斯宾斯儿童焦虑量表家长报告版（SCAS-P）评估6至9岁儿童的焦虑情况。此外，使用16S rRNA基因测序比较两组的肠道微生物群谱。(3) 结果：在行为测试中，反复接受麻醉的儿童中，强迫症和社交恐惧症的p-SCAS评分显著高于对照组。两组在惊恐发作和广场恐惧症、分离焦虑症、身体伤害恐惧、广泛性焦虑症以及SCAS-P总分方面无显著差异。在对照组中，22名儿童中有3名得分中度升高，但均无异常升高。在多次暴露组中，22名儿童中有5名得分中度升高，2名得分异常升高。然而，得分升高和异常升高的儿童数量未检测到统计学显著差异。数据表明，儿童反复接受麻醉和手术会导致长期严重的肠道微生物群失调。(4) 结论：在这项初步研究中，我们的发现表明，早期反复接触麻醉和手术会使儿童易患焦虑症以及长期肠道微生物群失调。我们应在更大的数据人群规模并进行详细分析的情况下证实这些发现。然而，作者无法证实失调与焦虑之间的关联。
