不同非药物手段联合干预对减轻学龄前儿童术前焦虑和苏醒期谵妄的疗效  

The effectiveness of various non-pharmacological interventions on reducing preschool children's preoperative anxiety and emergence delirium

作　　者：储海潮 田悦[1] 张金萍[1] CHU Hai-chao;TIAN Yue;ZHANG Jin-ping(Department of Anesthesiology,the Shengjing Hospital of China Medical University,Shenyang 110000,Liaoning,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110000

出　　处：《医学研究生学报》2021年第7期727-731,共5页Journal of Medical Postgraduates

摘　　要：目的对于多种非药物疗法联合应用于围手术期儿童以提升舒适感的相关研究鲜有报道。文中探讨3种非药物手段联合干预对减轻学龄前儿童术前焦虑和苏醒期谵妄的疗效。方法选择2019年7月-2020年8月在中国医科大学附属盛京医院择期行双侧扁桃体及腺样体切除术的患儿70例,年龄3~6岁,按照随机数字表法分为对照组与联合干预组,每组35例。联合干预组患儿在常规围术期治疗和监护的基础上接受漫画辅助的术前访视、卡通车分心干预以及在苏醒室播放家属鼓励视频3种非药物手段联合干预;对照组仅接受常规围术期治疗和监护。在术前访视时(T_(0))和患儿与家属分离进入术间时(T_(1))使用改良耶鲁术前焦虑评分量表(mYPAS)和视觉模拟评分法(VAS)分别评估患儿和家属的焦虑水平。在离开术间即刻(T_(2))、到达苏醒室15 min后(T_(3))使用儿童麻醉后苏醒期谵妄量表(PAED)对患儿进行评估。其他次要指标包括患儿家属满意度、术后恶心呕吐、夜惊、遗尿或其他术后不良行为。结果联合干预组T_(1)时刻患儿及家属焦虑水平显著低于对照组[51.67(36.67~55.00)分vs 33.33(28.33~53.33)分,P<0.05],T_(2)时刻苏醒期谵妄发生率联合干预组显著低于对照组(22.86%vs 51.43%,P<0.05),T_(2)、T_(3)时刻联合干预组PAED得分均显著低于对照组(P<0.05)。T_(0)至T_(1)时刻家属VAS评分的变化差值与患儿mYPAS评分的变化差值存在微弱的正相关关系(r=0.353,P=0.003)。联合干预组患儿家属满意度显著高于对照组。结论3种非药物手段联合干预可以显著降低学龄前儿童的术前焦虑水平和苏醒期谵妄发生率,提高患儿家属满意度。Objective The study on combination of several non-pharmacological therapies for children during the perioperative period to boost their comfort is barely reported.This study aims to investigate the effectiveness of three combined non-pharmacological interventions on reducing preschool children's preoperative anxiety and emergence delirium.Methods A total of seventy patients undergoing elective tonsillectomy and adenoidectomy from July 2019 to August 2020 in Shengjing Hospital of China Medical University and aging 3-6,were included in this study and divided into control group and experimental group by the method of random number table,with 35 patients each group.In addition to the routine perioperative treatment and monitoring,children in the experimental group received three other non-pharmacological interventions,including comic-assisted preoperative visits,cartoon car distraction,and family encouragement videos playing in the recovery room,whereas the control group only received routine perioperative treatment and monitoring.The modified Yale Preoperative Anxiety Scale(mYPAS)and the visual analogue scale(VAS)were used to assess the children's and parents'anxiety during the preoperative interview(T_(0))and when the child was separated from his family and entered the operating room(T_(1)).The Pediatric Anesthesia Emergence Delirium(PAED)was used to evaluate the emergence delirium(ED)immediately after leaving operating room(T_(2))and 15 minutes after arriving in the recovery room(T_(3)).Other secondary indicators include family satisfaction,postoperative nausea and vomiting,night terrors,enuresis or other postoperative maladaptive behaviors.Results The anxiety level of the children and parents in the experimental group at T_(1) was significantly lower than that of the control group(P<0.05).The incidence of emergence delirium in the experimental group at T_(2) was greatly lower compared to the control group(P<0.05),and the PAED scores of the experimental group at T_(2) and T_(3) were significantly lower versus the

关 键 词：非药物 学龄前 术前焦虑 苏醒期谵妄 

分 类 号：R749[医药卫生—神经病学与精神病学]