多方式干预对接受发育性髋关节脱位矫形手术患儿围手术期心理和疼痛的影响  

The effect of a multimodal intervention on perioperative psychology and pain in children undergoing an orthopedic operation for developmental dislocation of the hip

作　　者：邢艳红[1] 王迎斌[1] 谢圆[2] 杨爱萍[1] 张红晓[1] 黄生辉[1] Xing Yanhong;Wang Yingbin;Xie Yuan;Yang Aiping;Zhang Hongxiao;Huang Shenghui(Department of Anesthesiology,the Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Anesthesiology,Gansu Provincial Hospital of TCM,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院麻醉科,730030 [2]甘肃省中医院麻醉科,兰州730030

出　　处：《国际麻醉学与复苏杂志》2021年第9期928-932,共5页International Journal of Anesthesiology and Resuscitation

基　　金：甘肃省卫生行业科研计划项目(GSWSKY2018-41)。

摘　　要：目的探讨多方式干预对接受发育性髋关节脱位(developmental dislocation of hip, DDH)矫形手术患儿围手术期精神状态和疼痛的影响。方法选择择期行DDH矫形手术的患儿120例,ASA分级Ⅰ、Ⅱ级,年龄2~5岁,体重12~21 kg。采用随机数字表法将患儿分为4组:宣教+神经阻滞组(PN组)、宣教+术后镇痛组(PA组)、神经阻滞+术后镇痛组(NA组)、宣教+神经阻滞+术后镇痛组(PNA组),每组30例。4组患儿均常规诱导气管插管行全身麻醉,七氟醚、瑞芬太尼用于术中麻醉维持。PN组、PA组、PNA组患儿术前访视时给予动画视频宣教手术和麻醉过程,PN组、NA组、PNA组患儿全身麻醉诱导后给予超声引导下股外侧皮神经阻滞,PA组、NA组、PNA组患儿术后给予父母控制静脉镇痛。记录术前访视时(T_(0))、入手术室时(T_(1))、麻醉诱导时(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))、术后48 h(T5)患儿的心率、MAP、改良耶鲁围手术期焦虑量表(modified Yale Preoperative Anxiety Scale, mYPAS)评分。根据诱导期合作度量表(Induction Compliance Checklist, ICC)评估麻醉诱导时患儿的合作程度并记录ICC评分。同时测定并记录术后0.5 h(T′_(0))、术后2 h(T′_(1))、术后12 h(T′_(2))、术后24 h(T′_(3))、术后48 h(T′_(4))患儿VAS疼痛评分及术中芬太尼用药量。观察并记录围手术期寒战、恶心呕吐、呼吸抑制、出血等并发症发生情况。结果 4组患儿年龄、性别比、体重、手术时间、输液量及出血量等比较差异无统计学意义(P>0.05)。与NA组比较,PN组、PA组、PNA组患儿在T_(1)、T_(2)、T_(3)、T_(4)时的心率、MAP、mYPAS评分明显降低(P<0.05),而在T5时心率、MAP也明显降低(P<0.05)。与PNA组比较,PN组和PA组心率、MAP、mYPAS评分在T_(3)、T_(4)时明显升高,差异有统计学意义(P<0.05)。与NA组比较,PN组、PA组、PNA组患儿麻醉诱导时ICC评分明显降低(P<0.05)。与PA组比较,PN组、NA组、PNA组患�Objective To evaluate the effect of a multimodal intervention on children undergoing developmental dislocation of hip(DDH)orthopedic surgery.Methods One hundred and twenty American Society of Anesthesiologists(ASA)ⅠorⅡchildren aged 2-5 y,body mass 12-21 kg,scheduled for DDH orthopedic operation were allocated into 4 groups(n=30)according to random number table method,preoperative education and nerve block group(PN group),preoperative education and analgesia group(PA group),block and analgesia group(NA group),preoperative education,nerve block and analgesia group(PNA group).The children in PN,PA,and PNA groups were given animated videos during a preoperative visit to teach them the operation and anesthesia process.Subsequently,the children in PN,NA,PNA groups were treated with ultrasound-guided lateral femoral cutaneous nerve block after induction of general anesthesia.After the operation,children in PA,NA,PNA groups were given parent-controlled intravenous analgesia.Heart rate,mean arterial blood pressure(MAP)and modified Yale Preoperative Anxiety Scale(mYPAS)scores were recorded at the preoperative visit(T_(0)),entering the operating room(T_(1)),induction of general anesthesia(T_(2)),12 h after the operation(T_(3)),24 h after the operation(T_(4))and 48 h after the operation(T_(3)).The score of Induction Compliance Checklist(ICC)was also recorded at T_(2).The Visual Analogue Scale(VAS)scores and the dosage of fentanyl were measured and recorded at 0.5 h(T′_(0)),2 h(T′_(1)),12 h(T′_(2)),24 h(T′_(3)),48 h(T′_(4)).The complications of shivering,nausea and vomiting,respiratory depression,and bleeding were observed and recorded.Results There was no significant difference in age,sex ratio,body mass,anesthesia time,operation time,and bleeding volume among the four groups(P>0.05).Compared with the NA group,the heart rate,MAP and mYPAS scores of the PN,PA and PNA groups were significantly low(P<0.05)at T_(1),T_(2),T_(3) and T_(4).Heart rate and MAP at T5 were also appreciably low(P<0.05).Compared with PNA gr

关 键 词：术前宣教 神经阻滞 多方式干预 髋关节脱位 心理 疼痛 

分 类 号：R726.1[医药卫生—儿科]