Attention-Deficit/Hyperactivity Disorder After Early Exposure to Procedures Requiring General Anesthesia
Attention-Deficit/Hyperactivity Disorder After Early Exposure to Procedures Requiring General Anesthesia
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DOI：
10.1016/j.mayocp.2011.11.008
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发表时间：
2012-02-01
影响因子：
8.9
通讯作者：
Warner, David O.
中科院分区：
文献类型：
--
作者：
Sprung, Juraj;Flick, Randall P.;Warner, David O.
目的：为了研究暴露于2岁之前在全身麻醉下进行的程序与注意力缺陷/多动障碍（ADHD）的发展之间的关联，研究患者包括1976年1月1日至1982年12月31日出生在明尼苏达州罗切斯特的所有儿童，他们5岁后仍留在罗切斯特。在19岁之前诊断的ADHD病例是通过应用严格的研究标准确定的。考克斯比例风险回归评估暴露于需要全身麻醉的程序结果：在分析的5357名儿童中，341例ADHD病例被确定为ADHD的危险因素（估计累积发生率为7.6%; 95%置信区间[CI]为6.8%-8.4%）。对于出生后未暴露于需要麻醉的手术的儿童，19岁时ADHD的累积发病率为7.3%（95% CI，6.5%-8.1%）。对于单次和2次或2次以上暴露，估计值分别为10.7%（95% CI，6.8%-14.4%）和17.9%（95% CI，7.2%-27.4%）。在调整胎龄、性别、出生体重和共病健康状况后，（风险比，1.95; 95% CI，1.03-3.71），但不是单一（危害比，1.18; 95%CI，0.79-1.77），需要全身麻醉的手术与ADHD风险增加相关。在2岁前反复暴露于需要全身麻醉的手术的儿童，即使在调整合并症后，日后患ADHD的风险也会增加。(C)2012年马约医学教育和研究基金会广场马约临床学报201287（2）120-129
Objective: To study the association between exposure to procedures performed under general anesthesia before age 2 years and development of attention-deficit/hyperactivity disorder (ADHD).Patients and Methods: Study patients included all children born between January 1, 1976, and December 31, 1982, in Rochester, MN, who remained in Rochester after age 5. Cases of ADHD diagnosed before age 19 years were identified by applying stringent research criteria. Cox proportional hazards regression assessed exposure to procedures requiring general anesthesia (none, 1, 2 or more) as a predictor of ADHD using a stratified analysis with strata based on a propensity score including comorbid health conditions.Results: Among the 5357 children analyzed, 341 ADHD cases were identified (estimated cumulative incidence, 7.6%; 95% confidence interval [CI],.6.8%-8.4%). For children with no postnatal exposure to procedures requiring anesthesia before the age of 2 years, the cumulative incidence of ADHD at age 19 years was 7.3% (95% Cl, 6.5%-8.1%). For single and 2 or more exposures, the estimates were 10.7% ( 95% CI, 6.8%-14.4%) and 17.9% ( 95% Cl, 7.2%-27.4%), respectively. After adjusting for gestational age, sex, birth weight, and comorbid health conditions, exposure to multiple (hazard ratio, 1.95; 95% CI, 1.03-3.71), but not single (hazard ratio,1.18; 95% Cl, 0.79-1.77), procedures requiring general anesthesia was associated with an increased risk for ADHD.Conclusion: Children repeatedly exposed to procedures requiring general anesthesia before age 2 years are at increased risk for the later development of ADHD even after adjusting for comorbidities. (C) 2012 Mayo Foundation for Medical Education and Research square Mayo Clin Proc. 201287(2)120-129