学龄前儿童斜视手术术前遮光预处理预防苏醒期谵妄的效果  

Prevention of emergence delirium using eye shading pretreatment in preschool children after strabismus surgery

作　　者：魏薇[1] 孙振涛[1] 张增梅[1] 张莹[1] 赵海运[1] 张帅[1] 孙立群[1] 王宇[1] WEI Wei;SUN Zhentao;ZHANG Zengmei;ZHANG Ying;ZHAO Haiyun;ZHANG Shuai;SUN Liqun;WANG Yu(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,郑州450052

出　　处：《郑州大学学报（医学版）》2021年第5期727-730,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省卫生计生科技英才海外研修工程项目(HWYX2019064);河南省医学科技攻关计划项目(2018010006);河南省医学教育研究。

摘　　要：目的:探讨学龄前儿童斜视手术术前遮光预处理对苏醒期谵妄(ED)的预防效果。方法:根据是否进行遮光预处理将行双眼斜视矫正术的学龄前儿童(3~7岁)分为遮光预处理组(46例)、对照组(49例)两组。遮光预处理组模拟术后伤口纱布覆盖方式在术前3 d每天进行1 h的眼部遮光预处理,对照组不进行任何干预。两组患儿均进行相同的术前宣教。患儿苏醒后每5 min对患儿进行ED评分,>9分认为存在ED,>15分给予丙泊酚处理。记录FLACC疼痛评分、麻醉药停止至苏醒的时间和麻醉恢复室停留时间,记录家属满意度及苏醒期恶心呕吐、呼吸抑制和SpO_(2)<90%等不良事件。结果:两组患儿年龄、性别、体重和ASA分级差异无统计学意义(P>0.05)。与对照组相比,遮光预处理组ED发生率、丙泊酚补救率、ED最高评分和麻醉恢复室停留时间均降低(P<0.05),遮光预处理组家属非常满意率高于对照组(P=0.006)。两组患儿手术时间、FLACC疼痛评分和苏醒时间以及苏醒期恶心呕吐、呼吸抑制和SpO_(2)<90%等不良事件发生率差异无统计学意义(P>0.05)。结论:术前遮光预处理可以有效减少学龄前儿童斜视手术后ED的发生。Aim:To evaluate the effect of eye shading pretreatment on emergence delirium(ED)during recovery of general anesthesia in preschool children after strabismus surgery.Methods:Ninety-five preschool children(3-7 years old)who scheduled for binocular strabismus surgery were enrolled.According to whether the child obtained eye shading pretreatment or not,them were allocated into 2 groups,eye shading pretreatment group(46 cases)and control group(49 cases).Children in the eye shading pretreatment group were treated with eye shading simulating the gauze covering mode of postoperative wound one hour per day for three consecutive days before surgery.Children in the control group received no intervention.All children received the same preoperative education and other preoperative preparations.All children were evaluated by ED score every five minutes after waking up.A score>9 was considered to be ED while a score>15 was considered need to be treated with propofol.The FLACC pain score,recovery time,and the duration in the post-anesthesia care unit(PACU)were recorded.The satisfaction of children′s family members and the adverse events such as postoperative nausea and vomiting,respiratory depression,and SpO_(2)<90%during the recovery period were also recorded.Results:There were no significant differences in age,gender,weight or ASA classification between the 2 groups(P>0.05).Compared with the control group,the incidences of ED,the use of propofol,the highest ED score and the duration in PACU in eye shading pretreatment group were significantly lower(P<0.05).The very satisfaction of children′s family members in eye shading pretreatment group was higher than that in the control group(P=0.006).There were no significant differences in operation time,FLACC pain score,wake-up time or the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Eye shading pretreatment could effectively reduce the incidence of ED in preschool children during recovery after strabismus surgery.

关 键 词：遮光预处理 学龄前儿童 斜视手术 谵妄 

分 类 号：R614[医药卫生—麻醉学]