Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort.
Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort.
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DOI：
10.1097/aln.0b013e3181adf481
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发表时间：
2009-08
期刊：
影响因子：
8.8
通讯作者：
Warner DO
中科院分区：
文献类型：
--
作者：
Sprung J;Flick RP;Wilder RT;Katusic SK;Pike TL;Dingli M;Gleich SJ;Schroeder DR;Barbaresi WJ;Hanson AC;Warner DO
给未成熟的大脑注射麻醉剂可能会导致组织病理变化和长期的行为异常。在一项基于人群的出生队列中，确定了围产期在剖宫产(CD)期间暴露于麻醉药(CD)与学习障碍(LD)发展的相关性。回顾了1976-1982年居住在明尼苏达州奥姆斯特德县五个乡镇的母亲所生的所有孩子的教育和医疗记录，这些孩子在5岁时仍留在社区，以确定患有LDS的人。用COX比例风险回归分析比较经阴道分娩和经CD分娩(全身麻醉或区域麻醉)的LD发生率。在这个队列中的5,320名儿童中，497名通过CD分娩(全麻N=193，区域麻醉N=304)。LD的发生率取决于分娩方式(P=0.050，调整了性别、出生体重、胎龄、4岁之前的麻醉暴露和母亲教育)。全麻下经阴道分娩和经阴道分娩的LD风险相似，但在区域麻醉下接受CD分娩的儿童LD风险降低(风险比=0.64，95%可信区间0.44~0.92；区域麻醉下CD与经阴道分娩比较P=0.017)。在CD期间暴露于全身或区域麻醉下的儿童与经阴道分娩的儿童相比，并不更有可能发生LD，这表明围产期短暂暴露于麻醉药不会对长期神经发育结果产生不利影响。在母亲接受区域麻醉的CD分娩的儿童中，LD的风险可能较低。
Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort. The educational and medical records of all children born to mothers residing in five townships of Olmsted County, MN from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia). Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia N=193, and regional anesthesia N=304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia prior to age 4, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P=0.017 for comparison of CD under regional anesthesia compared to vaginal delivery). Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.