全麻诱导期多模式非药物处理对学龄前儿童苏醒期谵妄的影响  

Effect of multimodal non-drug treatment during induction of general anesthesia on emergence delirium in preschool children

作　　者：刘磊 孙盈盈 孙雅娟 夏寅 刘学胜[1] Liu Lei;Sun Yingying;Sun Yajuan;Xia Yin;Liu Xuesheng(Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Anesthesiology,Anhui Provincial Children′s Hospital,Hefei 230051,China)

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022 [2]安徽省儿童医院麻醉科,合肥230051

出　　处：《中华麻醉学杂志》2023年第9期1031-1036,共6页Chinese Journal of Anesthesiology

摘　　要：目的全麻诱导期多模式非药物处理对学龄前儿童苏醒期谵妄(ED)的影响。方法择期行鼾症手术患儿210例,性别不限,年龄3~6周岁,ASA分级Ⅰ或Ⅱ级,手术时间预计<2 h。根据计算机随机产生数字的奇偶性随机分为多模式非药物处理组(N组,n=102)和对照组(C组,n=108)。N组在诱导间进行全麻诱导,同时采用多模式非药物处理,包括父母陪伴、携带喜爱的玩具、便携式多媒体设备看喜欢的视频节目等,患儿全麻诱导完成后离开父母进入手术室;C组患儿随医护人员直接进入手术室进行麻醉诱导。2组均采用气管插管静吸复合全身麻醉。分别于术前24 h(T_(0))和麻醉诱导前即刻(T_(1)),行改良耶鲁术前焦虑量表(m-YPAS)评分。分别于入PACU后定向力恢复(T_(2))、术后6、24和72 h时行小儿麻醉苏醒期谵妄量表评分(PAED评分>12分定义为ED)、FLACC评分和Ramsay镇静评分。根据是否发生ED分为ED组和非ED组(NED组),将组间比较差异有统计学意义的因素纳入多因素logistic回归分析,筛选ED的危险因素并构建预测模型,采用受试者工作特征曲线评价模型预测的准确性。结果与C组比较,N组T_(1)时m-YPAS评分、T_(2)时PAED评分和ED发生率降低(P<0.05),各时点FLACC评分和Ramsay镇静评分差异无统计学意义(P>0.05)。年龄、T_(1)时m-YPAS评分、全麻诱导期多模式非药物处理、T_(2)时FLACC评分和T_(2)时Ramsay镇静评分是患儿ED发生的危险因素(P<0.05)。受试者工作特征曲线下面积为0.944,95%CI为0.914~0.974,约登指数为0.779,灵敏度为94.9%,特异度为83%,诊断界值为0.14。结论全麻诱导期多模式非药物处理可有效减少学龄前儿童ED的发生。Objective To evaluate the effect of multimodal non-drug treatment during induction of general anesthesia on emergence delirium(ED)in the preschool children.Methods A total of 210 pediatric patients of either sex,aged 3-6 yr,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective operation for snoring with expected operation time<2 h,were involved in this study.The patients were divided into 2 groups according to the parity of the numbers randomly generated by the computer:multimodal non-drug treatment group(group N,n=102)and control group(group C,n=108).In group N,multiple modes of non-drug intervention(including parents′company,carrying favorite toys,watching favorite video programs with portable multimedia devices,etc)were used during anesthesia induction,and the children left their parents and entered the operating room after completion of general anesthesia.The children directly entered the operating room with the medical staff for anesthesia induction(without parents′company and other intervention measures)in group C.The patients were endotracheally intubated and received combined intravenous-inhalational anesthesia and general anesthesia in both groups.The anxiety was evaluated by modified Yale preoperative anxiety scale(m-YPAS)score at 24 h before operation(T_(0))and immediately before induction of general anesthesia(T_(1)).The Pediatric Anesthesia Emergence Delirium scale score(PAED score,ED was defined as PAED score>12),FLACC scale score and Ramsay Sedation Scale score were recorded when orientation recovered after admission to postanesthesia care unit(T_(2))and at 6,24 and 72 h after operation.The patients were divided into ED group and non-ED group(NED group)according to the occurrence of ED,and the risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify ED-related risk factors and construct the prediction model.The accuracy of the prediction model was evaluated by the receiver operating cha

关 键 词：麻醉 全身 儿童 学龄前 苏醒谵妄 多模式非药物处理 

分 类 号：R726.1[医药卫生—儿科]