【原】【罂粟摘要】产妇在分娩时使用硬膜外镇痛对胎儿行为和神经心理结果的影响

产妇在分娩时使用硬膜外镇痛对胎儿行为和神经心理结果的影响

贵州医科大学                麻醉与心脏电生理课题组

翻译：文春雷              编辑：田明德   审校：曹莹

背景：最近的研究关于产妇硬膜外镇痛（LEA）与其子女神经发育障碍之间的关系仍有争议。我们评估了使用LEA产妇的子女的行为和神经心理测试分数。

方法：评估自1989年至1992年期间，在西澳大利亚的Raine研究中登记的、单胎妊娠并自然分娩的儿童。将暴露与LEA的儿童与未暴露的儿童进行比较。主要结果是父母报告的10岁时的儿童行为检查表（CBCL）的总分、内化和外化行为问题分数。评估了分数差异、临床缺陷风险的增加，及LEA暴露时间与结果之间的剂量反应关系。次要结果包括语言、运动功能、认知和自闭症特质。

结果：在2180名儿童中，有850名（39.0%）暴露于LEA。调整协变量后，暴露于LEA的儿童CBCL总分轻微增加（+1.41分；95%置信区间[CI] 0.09-2.73；P=0.037），但内化（+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）子分数无明显改变。没有观察到任何CBCL分数的临床缺陷风险增加。次要结果中，在运动功能和认知方面的分数差异不一致。暴露时间的增加与任何结果的较低分数无明显关联。

 

结论：虽然LEA暴露与总行为分数的轻微上升相关，但没有发现子分数差异、临床缺陷风险增加或剂量-反应关系。这些结果反驳了LEA暴露与儿童中一致且临床显著的神经发育缺陷相关的观点。

原始文献来源

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.