早期接触全身麻醉可能会导致日后注意力缺陷多动障碍（ADHD）：队列研究的系统评价和荟萃分析。

Early exposure to general anesthesia may contribute to later attention-deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis of cohort studies.

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.

State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

出版信息

J Clin Anesth. 2024 Nov;98:111585. doi: 10.1016/j.jclinane.2024.111585. Epub 2024 Aug 16.

DOI:10.1016/j.jclinane.2024.111585

PMID:39153353

Abstract

STUDY OBJECTIVE

The association between early childhood exposure to general anesthesia and subsequent risk of developing attention-deficit/hyperactivity disorder remains unknown.

DESIGN

A systematic review and meta-analysis of cohort studies.

PATIENTS

Children undergoing general anesthesia.

INTERVENTIONS

A comparison of any type of general anesthesia exposure, including total intravenous anesthesia, inhalation general anesthesia, and combined intravenous and inhaled anesthesia, with non-anesthetic exposures, which did not receive any exposure to anesthetic drugs, including general anesthetics as well as local anesthetics.

MEASUREMENTS

The primary outcome measure was the risk of developing attention-deficit/hyperactivity disorder after general anesthesia exposure.

MAIN RESULTS

The results of the overall meta-analysis showed an increased risk of subsequent attention-deficit/hyperactivity disorder in children exposed to general anesthesia (RR = 1.26, 95% CI, 1.16-1.38; P < 0.001; I = 44.6%). Subgroup analysis found that a single exposure to general anesthesia in childhood was associated with an increased risk of developing attention-deficit/hyperactivity disorder (RR = 1.29, 95% CI, 1.19-1.40, P < 0.001; I = 2.6%), and the risk of attention-deficit/hyperactivity disorder was further increased after multiple general anesthesia exposures (RR = 1.61, 95% CI, 1.32-1.97, P < 0.001; I = 57.6%). Exposure to general anesthesia lasting 1-60 min during childhood is associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) (RR: 1.38, 95% CI: 1.26-1.51, P < 0.001; I = 0.0%). Moreover, with longer durations of exposure (61-120 min), the risk further rises (RR: 1.55, 95% CI: 1.21-1.99, P = 0.001; I = 37.8%). However, no additional increase in ADHD risk was observed with exposures exceeding 120 min (RR: 1.55, 95% CI: 1.35-1.79, P < 0.001; I = 0.0%).

CONCLUSIONS

Exposure to general anesthesia during early childhood increases the risk of developing attention-deficit/hyperactivity disorder. In particular, multiple general anesthesia exposures and exposures longer than 60 min significantly increase the risk of developing ADHD.

摘要

研究目的

幼儿期全身麻醉暴露与随后发生注意缺陷多动障碍（ADHD）的风险之间的关系尚不清楚。

设计

系统评价和队列研究的荟萃分析。

患者

接受全身麻醉的儿童。

干预措施

将任何类型的全身麻醉暴露（包括全静脉麻醉、吸入全身麻醉和静脉吸入联合麻醉）与非麻醉暴露（未接受任何麻醉药物暴露，包括全身麻醉和局部麻醉）进行比较。

测量指标

主要观察指标为全身麻醉暴露后发生 ADHD 的风险。

主要结果

总体荟萃分析结果显示，全身麻醉暴露的儿童发生 ADHD 的风险增加（RR=1.26，95%CI，1.16-1.38；P<0.001；I²=44.6%）。亚组分析发现，儿童时期单次全身麻醉暴露与发生 ADHD 的风险增加相关（RR=1.29，95%CI，1.19-1.40，P<0.001；I²=2.6%），多次全身麻醉暴露后 ADHD 的风险进一步增加（RR=1.61，95%CI，1.32-1.97，P<0.001；I²=57.6%）。儿童期 1-60 分钟的全身麻醉暴露与 ADHD 风险增加相关（RR：1.38，95%CI：1.26-1.51，P<0.001；I²=0.0%）。此外，随着暴露时间的延长（61-120 分钟），风险进一步升高（RR：1.55，95%CI：1.21-1.99，P=0.001；I²=37.8%）。然而，暴露时间超过 120 分钟时，ADHD 风险无进一步增加（RR：1.55，95%CI：1.35-1.79，P<0.001；I²=0.0%）。