| Part Ⅰ Evaluation of neurocognitive function in children with leukemia after multiple exposure to general anesthesiaObjective:To evaluate the neurocognitive outcomes in children with leukemia undergoing general anesthesia after one year,and to provide evidence for the impact of general anesthesia on cognitive development in China.Methods:A total of 49 children with acute lymphoblastic leukemia who underwent triple intrathecal chemotherapy in Children’s Hospital of Soochow University were enrolled from January 2018 to January 2020.Depending on whether exposure to general anesthesia divided into general anesthesia group(GA)and regional anesthesia group(RA),the children were assessed for cognitive function after one year from the diagnosis,and the age of the assessment was 6-12 years(school age).The composite scores of total IQ and indices were obtained from the assessment of children’s cognitive function used by the Chinese version of the fourth edition of the Wechsler Intelligence Scale for Children(WISC-Ⅳ)and compared with the normal values of the norm.Besides,according to the age at diagnosis,it was divided into 3-6 years old group(preschool group)and 6-12 years old group(school-aged group),then compared with the domestic normal value and make a comparison between groups.Results:1.A total of 49 children were included in this study,with 32 cases in the GA group(65.3%)and 17 cases in the RA group(34.7%).There were 27 males(55.1%)and 22 females(44.9%).22 cases(44.9%)aged under 6,27 cases(55.1%)aged 6-12.2.The full scale IQ of 49 children with ALL was 102.201±7.94.which was not statistically significant compared with the domestic normal value of 100±15(P=0.058),but verbal comprehension index,perceptual reasoning index and general ability index were significantly higher than the normal value(P<0.01),and the working memory index,processing speed index,and cognitive productivity index were significantly lower than the normal value(P<0.01).3.The FSIQ of the GA group and the RA group were 101.97±7.52 and 102.65±8.89 respectively,with no statistical difference compared with the normal value(P>0.05);the other indexes of the GA group were clearly significant compared with the normal value(P<0.05),in which the verbal comprehension index,perceptual reasoning index,and general ability index were significantly higher than normal values(P<0.01),and the working memory index,processing speed index,and cognitive productivity index were significantly lower than normal values(P<0.01).The verbal comprehension index and general ability index of the RA group were statistically different from the normal value(P<0.01),and the cognitive efficiency index was lower than the normal value(t=-2.276,P=0.037).4.Compared with the RA group,the processing speed index(t=-2.207,P=0.032)and the cognitive productivity index(t=-2.320,P=0.025)were statistically significant,and the GA was lower than the RA group.The other indexes were no significant differences between the two groups.5.There was no statistical difference in the WISC-Ⅳ between preschool-aged children and school-aged children in the GA and RA groups(P>0.05).The cognitive productivity index scores of the full sample of preschool-aged children was 91.36±6.48,and that of school-aged children was 95.04±4.83,with statistical differences(t=-2.273,P=0.028).But there was no difference in the WISC-Ⅳ between the different genders in each group(P>0.05).Conclusion:1.Children with acute lymphoblastic leukemia over 3 years of age who were exposed to multiple general anesthesia are associated with deficits in processing speed,regardless of gender and age at diagnosis.2.The ability of memory and processing speed of children with acute lymphoblastic leukemia lags behind the average of normal children in China.Part Ⅱ Analysis of factors affecting cognitive function of children with leukemiaObjective:To analyze the possible factors that affect the cognitive development of children with leukemia,so as to provide clinical references for improving the long-term prognosis of children with leukemia who have undergone multiple exposure to anesthesia.Methods:The WISC-ⅣV of Chinese version was used to evaluate the cognitive function of 49 ALL children,and the full scale IQ and the composite score of each index were obtained.The data of 49 children before and after treatment of ALL were gathered,including gender,age at diagnosis,height,weight,parents’ highest education level,age at the time of evaluation,and data on duration and cumulative dosage of all anesthetics,including tranquilizers,analgesics,and inhaled anesthetics(numbers),the number of general anesthesia exposures,the total cumulative time of general anesthesia,the number of chemotherapy,etc.Logistic regression analysis method is used to explore the risk factors that lead to cognitive deficits in children with ALL.Results:1.The number of exposures to general anesthesia(OR=1.114,95%CI 1.002-1.238,P=0.046)and total hospital days(OR=1.094,95%CI 1.030-1.162,P=0.003)can be used as predictors of processing speed.That is,the higher the number of general anesthesia exposures and the longer the total hospital days,the higher the risk of poor processing speed.2.Age at diagnosis(OR=0.956,95%CI 0.922-0.992,P=0.017),parents’ highest education level(OR=0.167,95%CI 0.041-0.684,P=0.013)can be used as predictors of cognitive productivity index.That is,the younger the diagnosis age and the lower the education level of the parents,the higher the risk of cognitive productivity impairment of children with ALL.Conclusion:The risk factors of cognitive development deficits in children with acute lymphoblastic leukemia include the number of exposures to general anesthesia,the total days in hospitalization,the age at diagnosis,and the education level of the parents. |
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