新生儿心脏手术的围手术期麻醉暴露与1岁神经发育状况的关系

目的：探讨新生儿心脏手术的围手术期麻醉暴露与1岁时的神经发育结果的相关性。方法：选取四川省人民医院行心脏手术的新生儿115例，纳入队列研究，于术前和术后7 d行大脑磁共振(MRI)，记录围手术期挥发性麻醉药、苯二氮卓类与阿片类药物使用情况，患儿1岁时应用贝利婴幼儿发展量表评估患儿的认知、语言和运动情况，在矫正其他协变量基础上分析它们的相关性。结果：共有92例患儿被纳入研究，患儿1岁时贝利婴幼儿发展量表认知、语言和运动的分值分别为104.2±14.7，85.6±11.3和86.9±13.5；术前MRI显示颅脑损伤17例，术后MRI显示颅脑损伤25例。多重线性回归分析显示与1岁神经发育结果相关的因素包括MRI显示术后脑损伤、挥发性麻醉药的最低肺泡有效浓度、芬太尼总质量浓度、苯二氮卓类总质量浓度、ICU住院时间、术前平均区域脑氧饱和度和染色体异常。结论：挥发性麻醉药暴露、术后MRI显示脑损伤以及长ICU住院时间是患儿1岁时神经发育预后差的影响因素。需要采取针对性的措施，降低围手术期致神经损伤的危险因素。

Perioperative anesthetic exposure and the neurodevelopmental status of 1 year old baby underwent neonatal cardiac surgery

Objective: To determine the association between perioperative anesthetic exposure and neurodevelopmental status at age 1 year old baby underwent complex cardiac surgery. Methods: One hundred and fifteen infants were selected from Sichuan People’s Hospital. A cohort study was conducted on neonates who underwent complex cardiac surgery. The babies were performed brain MRI before the operation and 7days after the operation, and 12-month neurodevelopmental testing was carried out with Bayley Scales of Infant and Toddler Development (the third Edition, Bayley-III). Doses of volatile anesthetics (VAA), benzodiazepines, and opioids were determined during the 12 months. The association between peri-operative anesthetic exposure and 12-month neurodevelopmental status were analyzed. Results: A total of 92 infants were enrolled for the final analysis. Their Bayley-III scores of cognitive, language, and movement were as follows: 104.2±14.7, 85.6±11.3, and 86.9±13.5, respectively. MRI results showed that 17 infants showed pre-operative brain injury and 25 infants showed new post-operative injury. After performing the analysis of stepwise multivariable linear regression, MRI showed the factors affecting neurodevelopment of newborn include the new post-operative injury, higher VAA exposure, fentanyl dose, benzodiazepine dose, ICU length of stay, pre-operative mean regional cerebral oxygen saturation (rSO2), and abnormal chromosomes. Conclusion: VAA exposure and ICU length of stay are associated with poor neurodevelopmental scores at 12 months of age. Further studies need to identify the potential modifiable factors in the peri-operative care of neonates to improve neurodevelopmental outcomes.