【原】【罌粟摘要】產(chǎn)婦在分娩時(shí)使用硬膜外鎮(zhèn)痛對(duì)胎兒行為和神經(jīng)心理結(jié)果的影響

罌粟花anesthGH 2024-08-07 發(fā)布于貴州

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產(chǎn)婦在分娩時(shí)使用硬膜外鎮(zhèn)痛對(duì)胎兒行為和神經(jīng)心理結(jié)果的影響

貴州醫(yī)科大學(xué) 麻醉與心臟電生理課題組

翻譯：文春雷編輯：田明德審校：曹瑩

背景：最近的研究關(guān)于產(chǎn)婦硬膜外鎮(zhèn)痛（LEA）與其子女神經(jīng)發(fā)育障礙之間的關(guān)系仍有爭(zhēng)議。我們?cè)u(píng)估了使用LEA產(chǎn)婦的子女的行為和神經(jīng)心理測(cè)試分?jǐn)?shù)。

方法：評(píng)估自1989年至1992年期間，在西澳大利亞的Raine研究中登記的、單胎妊娠并自然分娩的兒童。將暴露與LEA的兒童與未暴露的兒童進(jìn)行比較。主要結(jié)果是父母報(bào)告的10歲時(shí)的兒童行為檢查表（CBCL）的總分、內(nèi)化和外化行為問(wèn)題分?jǐn)?shù)。評(píng)估了分?jǐn)?shù)差異、臨床缺陷風(fēng)險(xiǎn)的增加，及LEA暴露時(shí)間與結(jié)果之間的劑量反應(yīng)關(guān)系。次要結(jié)果包括語(yǔ)言、運(yùn)動(dòng)功能、認(rèn)知和自閉癥特質(zhì)。

結(jié)果：在2180名兒童中，有850名（39.0%）暴露于LEA。調(diào)整協(xié)變量后，暴露于LEA的兒童CBCL總分輕微增加（+1.41分；95%置信區(qū)間[CI] 0.09-2.73；P=0.037），但內(nèi)化（+1.13分；95% CI -0.08-2.34；P=0.066）或外化（+1.08分；95% CI -0.08-2.24；P=0.068）子分?jǐn)?shù)無(wú)明顯改變。沒(méi)有觀察到任何CBCL分?jǐn)?shù)的臨床缺陷風(fēng)險(xiǎn)增加。次要結(jié)果中，在運(yùn)動(dòng)功能和認(rèn)知方面的分?jǐn)?shù)差異不一致。暴露時(shí)間的增加與任何結(jié)果的較低分?jǐn)?shù)無(wú)明顯關(guān)聯(lián)。

結(jié)論：雖然LEA暴露與總行為分?jǐn)?shù)的輕微上升相關(guān)，但沒(méi)有發(fā)現(xiàn)子分?jǐn)?shù)差異、臨床缺陷風(fēng)險(xiǎn)增加或劑量-反應(yīng)關(guān)系。這些結(jié)果反駁了LEA暴露與兒童中一致且臨床顯著的神經(jīng)發(fā)育缺陷相關(guān)的觀點(diǎn)。

原始文獻(xiàn)來(lái)源

Oliver G. Isik，Shaqif Junaid，Ling Guo, et al. Behavioural and neuropsychological outcomes in children exposed in utero to maternal labour epidural analgesia.[J].Critical Care Medicine, 2024.

Behavioural and neuropsychological outcomes in children exposed in utero to maternal labour epidural analgesia

Background: Recent studies report conflicting results regarding the relationship between labour epidural analgesia (LEA) in mothers and neurodevelopmental disorders in their offspring. We evaluated behavioural and neuropsychological test scores in children of mothers who used LEA.

Methods:Children enrolled in the Raine Study from Western Australia and delivered vaginally from a singleton pregnancy between 1989 and 1992 were evaluated. Children exposed to LEA were compared with unexposed children. The primary outcome was the parent-reported Child Behaviour Checklist (CBCL) reporting total, internalising, and externalising behavioural problem scores at age 10 yr. Score differences, an increased risk of clinical deficit, and a doseresponse based on the duration of LEA exposure were assessed. Secondary outcomes included language, motor function, cognition, and autistic traits.

Results: Of 2180 children, 850 (39.0%) were exposed to LEA. After adjustment for covariates, exposed children had minimally increased CBCL total scores (+1.41 points; 95% confidence interval [CI] 0.09 to 2.73; P=0.037), but not internalising (+1.13 points; 95% CI -0.08 to 2.34; P=0.066) or externalising (+1.08 points; 95% CI -0.08 to 2.24; P=0.068) subscale subscores. Increased risk of clinical deficit was not observed for any CBCL score. For secondary outcomes, score differences were inconsistently observed in motor function and cognition. Increased exposure duration was not associated with worse scores in any outcomes.

Conclusions:Although LEA exposure was associated with slightly higher total behavioural scores, there was no difference in subscores, increased risk of clinical deficits, or doseeresponse relationship. These results argue against LEA exposure being associated with consistent, clinically significant neurodevelopmental deficits in children.