Pediatric anesthesia and neurodevelopmental impairments: a Bayesian meta-analysis.
Pediatric anesthesia and neurodevelopmental impairments: a Bayesian meta-analysis.
复制标题
DOI：
10.1097/ana.0b013e31826a038d
复制
发表时间：
2012-10
影响因子：
3.7
通讯作者：
Li G
中科院分区：
文献类型：
--
作者：
DiMaggio C;Sun LS;Ing C;Li G
麻醉所致神经毒性的实验证据引起了人们对常用的挥发性麻醉剂对幼儿的长期影响的严重担忧。在现有数据的基础上进行了几项观察性研究，以解决这一关切，但结果不一致。我们进行了一项荟萃分析，以综合有关麻醉/手术与儿童神经发育结果之间关系的流行病学证据。使用贝叶斯荟萃分析方法，我们估计了综合优势比(OR)和95%可信区间(CRI)，以及在综合证据的情况下未来研究的预测分布。从7项研究中提取了7项未调整的和6项已调整的关联测量的数据。根据麻醉/手术与不良行为或发育结局的7项未调整措施计算的综合OR为1.9(95%CRI1.2，3.0)。未来研究最有可能的未调整OR估计为2.2(95%CRI 0.6，6.1)。根据麻醉/手术与不良行为或发育结局相关的6项调整措施，综合OR为1.4(95%CRI0.9，2.2)。未来研究最有可能调整的OR估计为1.5(95%CrI0.5，4.0)。我们的结论是，现有的流行病学证据表明，在童年早期暴露于麻醉/手术的儿童中，不良行为或发育结果的风险略有增加。然而，现有流行病学证据的不确定性是相当大的，这意味着利用现有数据来源进行额外研究以加强证据基础的价值正在减少。
Experimental evidence of anesthesia-induced neurotoxicity has caused serious concern about the long-term effect of commonly used volatile anesthetic agents on young children. Several observational studies based on existing data have been conducted to address this concern with inconsistent results. We conducted a meta-analysis to synthesize the epidemiologic evidence on the association of anesthesia/surgery with neurodevelopmental outcomes in children. Using Bayesian meta-analytic approaches, we estimated the synthesized odds ratios (OR) and 95% credible interval (CrI) as well as the predictive distribution of a future study given the synthesized evidence. Data on 7 unadjusted and 6 adjusted measures of association were abstracted from 7 studies. The synthesized OR based on the 7 unadjusted measures for the association of anesthesia/surgery with an adverse behavioral or developmental outcome was 1.9 (95% CrI 1.2, 3.0). The most likely unadjusted OR from a future study was estimated to be 2.2 (95% CrI 0.6, 6.1). The synthesized OR based on the 6 adjusted measures for the association of anesthesia/surgery with an adverse behavioral or developmental outcome was 1.4 ( 95% CrI 0.9, 2.2). The most likely adjusted OR from a future study was estimated to be 1.5 (95% Cr I 0.5, 4.0). We conclude that the existent epidemiologic evidence suggests a modestly elevated risk of adverse behavioral or developmental outcomes in children who were exposed to anesthesia/surgery during early childhood. The uncertainty with the existent epidemiologic evidence, however, is considerable, implying that the value of additional research using existent data sources to enhance the evidence base is diminishing.