儿童和随后的神经行为诊断中的手术麻醉暴露:使用尾切除术的自然实验
Jeffrey H Silber1, Paul R Rosenbaum2, Joseph G Reiter3
1Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Anesthesiology
|May 16, 2024
概括
儿童尾切除术与以后的行为和情绪障碍有轻微的关联,但在没有麻醉的医疗入院的儿童中,这种风险更高. 医疗条件,而不是麻醉,似乎是这些神经行为结果的主要驱动因素.
科学领域:
- 儿科神经发育研究
- 麻醉学和手术的结果.
- 公共卫生和流行病学.
背景情况:
- 对麻醉神经毒性的观察性研究可能会被儿童的先前存在的疾病所混.
- 儿童尾炎手术是一个自然实验,以分离麻醉的特定神经行为影响.
- 这项研究旨在区分与麻醉有关的神经行为结果与潜在的医疗条件.
研究的目的:
- 调查儿童麻醉与手术之间的特定关联以及随后的神经行为结果.
- 为了比较经历尾切除术的儿童与其他医疗入院儿童的神经行为风险.
- 通过将结果与匹配的健康对照进行比较,以控制混因素.
主要方法:
- 一项使用Medicaid数据 (2001-2018) 的大型队列研究,包括134,388名尾切除的健康儿童和671,940名匹配的对照.
- 对照组包括154,887名健康儿童,没有麻醉的医疗住院 (肺炎,细胞炎,胃肠炎) 和774,435名匹配的对照.
- 使用差异差异分析来比较尾切除和医疗入院组之间的结果,相对于他们的对照.
主要成果:
- 与对照组相比,尾切除术的儿童在随后的行为障碍 (HR 1.04) 和情绪/焦虑障碍 (HR 1.15) 中出现了小但显著的增加.
- 住院儿童的后续行为障碍 (HR 1.20) 和情绪/焦虑障碍 (HR 1.25) 的发生率高于对照组.
- 关键的是,医疗入院患者的神经行为问题率明显高于尾切除术患者,即使在对照人群进行控制后.
结论:
- 尾切除术和神经行为诊断之间的关联并不特定于麻醉暴露.
- 潜在的医疗条件,如非麻醉医疗入院的更高率所证明,与随后的神经行为问题比尾切除本身更有联系.
- 研究结果表明,先前存在的健康状况,而不是麻醉或尾炎手术,是儿童神经行为结果的更重要因素.
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