早期接触全身麻醉可能会导致日后出现注意力缺陷/多动症（ADHD）：队列研究的系统回顾和荟萃分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-08-16 DOI:10.1016/j.jclinane.2024.111585

Hao Zhou , Wenyi Sun , Liuxian Ning , Jie Kang , Yadong Jin , Chaoxuan Dong

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引用次数: 0

摘要

设计对队列研究进行系统回顾和荟萃分析。患者接受全身麻醉的儿童。干预措施对任何类型的全身麻醉暴露（包括全静脉麻醉、吸入式全身麻醉、静脉和吸入式联合麻醉）与非麻醉暴露（不接触任何麻醉药物，包括全身麻醉药和局部麻醉药）进行比较。主要结果总体荟萃分析结果显示，接触过全身麻醉的儿童随后出现注意力缺陷/多动症的风险增加（RR = 1.26，95% CI，1.16-1.38；P <；0.001；I2 = 44.6%）。亚组分析发现，儿童期单次接触全身麻醉与患注意力缺陷/多动障碍的风险增加有关（RR = 1.29，95% CI，1.19-1.40，P <0.001；I2 = 2.6%），多次接触全身麻醉后，患注意力缺陷/多动障碍的风险进一步增加（RR = 1.61，95% CI，1.32-1.97，P <0.001；I2 = 57.6%）。儿童期全身麻醉持续 1-60 分钟与注意力缺陷/多动症（ADHD）风险增加有关（RR：1.38，95% CI：1.26-1.51，P <0.001；I2 = 0.0%）。此外，接触时间越长（61-120 分钟），风险越高（RR：1.55，95% CI：1.21-1.99，P = 0.001；I2 = 37.8%）。结论幼儿期接触全身麻醉会增加患注意力缺陷/多动症的风险。结论幼儿期接触全身麻醉会增加患注意力缺陷/多动障碍的风险，尤其是多次接触全身麻醉和接触时间超过60分钟会显著增加患注意力缺陷/多动障碍的风险。

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

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; I² = 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; I² = 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; I² = 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; I² = 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; I² = 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; I² = 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.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.