目標：麻醉是一個複雜的藥理反應，全身麻醉對小兒中樞神經系統是否有影響，ㄧ直是人們關注的問題，本研究目的為利用全民健保資料庫分析，瞭解手術麻醉時間對不同年齡幼兒中樞神經系統疾病之相關性。方法：資料來源為2000年「全民健康保險學術研究資料庫」之100萬人承保抽樣歸人檔。本研究分析1997至2009年之申報資料；以六歲前曾執行手術麻醉的幼兒為研究對象，將未手術的對照組依研究組個案性別、年齡進行配對。結果： 6歲前手術麻醉患者共有6608位，以半閉鎖式或閉鎖循環式氣管內插管全身麻醉法麻醉佔77.9%最高，執行手術麻醉平均年齡3.6歲，中樞神經疾病發生率為10.75（千人年）風險比率1.35,(95%信賴區間1.23-1.47)，較未手術麻醉幼兒發生率8.02（千人年）高。執行半開放式或半閉鎖式面罩吸入全身麻醉者發生中樞神經疾病累計發生率為10.61千人日，發生中樞神經疾病的風險比率為1.30（95%信賴區間= 1.09-1.54）；半閉鎖式或閉鎖循環式氣管內插管全身麻醉者發生中樞神經疾病累計發生率為10.83千人日，發生中樞神經疾病的風險比率為1.36（95%信賴區間 1.23-1.50），結論：麻醉時間與中樞神經疾病相關性結果未達統計意義，可能與時間組距大及個案數相關。二種麻醉方法發生中樞神經疾病風險比皆較未手術麻醉組高。建議：本研究為健保資料庫檔案資料，若申報資料能將時間再細分，未來研究可能發現其差異性。另外，建議政府應加強宣導六歲幼兒免費健檢政策，讓所有家長皆能了解，確實帶嬰幼兒至醫療院所執行健康檢查，曾執行麻醉手術者應註記於健保手冊，執行發展評估時能更早發現幼兒的異狀，盡早接受相關介入措施，定期追蹤幼兒身心發展狀況，降低日後發生中樞神經疾病之嚴重度，增進孩子及父母的生活品質，進而降低醫療耗用及社會成本。
Goals: Anesthesia is a complex pharmacological reaction. Whether general anesthesia will affect central nervous system in children is always the concern. The purpose of this study is to determine whether the duration of anesthesia have an impact on the certral nervous system at different age group of children under the database analysis from the National Health Insurance. Methods:Under "National Health Insurance Research Database of the year 2000, 1 million samples were collected. From 1997 to 2009,children who underwent anesthesia before the age of six was the sample group.While the control group which who have not underwent anstheaia was matched based on gender and age. Results: Total 6608 children underwent anesthesia before age of six in 1997-2009.Above them, intratracheal intubation which accounts 77.9% of all general anesthesia is the highest method .The mean age of anesthesia is 3.6 years old .The incidence rate of central nervous system diseases in children who have anesthesia is 10.75 per1000 person- years with odds ratio of 1.35 (95% CI= 1.23-1.47)which was higher than children without anesthesia (8.02 per 1000 person- years). In Semi-opened or semi-closed mask method group, the cumulative incidence rate of central nervous system diseases is 10.61 per1000 person- years with risk odds of 1.30 (95% CI = 1.09-1.54).In semi-closed or closed intratracheal intubation method group, the cumulative incidence rate of central nervous system diseases is 10.83 per1000 person- years, with odds ratio of 1.36 (95% CI= 1.23-1.50). Conclusion: The duration of anesthesia is not statistically significant to the incidence rate of central nervous system disease. The smaller group number and the smaller gap of grouping age were considered the cause. Both mask and intubation methods of general anesthesia have the higher odds ratio to central nervous system diseases than those who doesn’t have anesthesia. Recommendation: This study was based on the database of the National Health Insurance database.If more detailed grouping age was disclosed,the statistical result may have the difference. In addition, the Government could advocates more on the campaign of regular health examination below the age of six, so that all parents would take their children to the medical institutions for regular health examination. Anesthesia also should be annotated on the NHI manual. Therefore doctors,who assess the development milestone will notice the abnormalities earlier,and will manage them earlier.Regular follow up of physical and mental development would reduce the severity of central nervous system diseases. In that way,the life quality in those children and their parents would improve.The medical costs would also declined.
