烧伤手术患儿术前焦虑与术后疼痛的危险因素及相关性分析  

Risk factors for preoperative anxiety and postoperative pain in children undergoing burn surgery and their relationship

作　　者：武玉红 庄蕾[1] 王凤乔 WU Yuhong;ZHUANG Lei;WANG Fengqiao(Department of Anesthesiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,上海200025

出　　处：《上海医学》2023年第12期840-848,共9页Shanghai Medical Journal

摘　　要：目的 探索影响烧伤手术患儿术前焦虑与术后疼痛的危险因素及两者的相关性。方法 前瞻性研究2019年9月—2021年3月于上海交通大学医学院附属瑞金医院行烧伤手术的1~14岁患儿104例。术前收集患儿的人口统计学资料及被调查者(父母)的特质/状态焦虑问卷,包括患儿及父母的年龄、性别、居住地、家庭年收入等;进入手术室后使用改良耶鲁术前焦虑量表(m-YPAS)评估患儿焦虑水平;术中收集患儿临床资料,包括患儿烧伤面积、烧伤深度、术前烧伤时间、手术方式、手术面积、术前心率、术中舒芬太尼总量等;在麻醉后监测治疗室(PACU)和术后4 h、24 h、48 h、72 h五个时间点,分别使用行为疼痛量表和Wong-Baker面部表情疼痛量表评估1~3岁和4~14岁患儿的疼痛状况,并记录患儿在PACU是否有补救镇痛及补救镇痛药物总量。组间比较采用两独立样本t检验或两独立样本秩和检验,将单因素分析中P<0.15的变量纳入多因素logistic回归分析,以确定患儿术前焦虑和术后疼痛的独立危险因素。采用Spearman检验评估烧伤患儿术前焦虑与术后疼痛的相关性。结果 根据年龄将患儿分为1~3岁组(60例)与4~14岁组(44例)。1~3岁组患儿术前m-YPAS评分为(60.76±23.22)分,显著高于4~14岁组[(39.49±18.29)分,χ^(2)=5.418,P<0.001]。烧伤患儿术前高度焦虑的发生率为61.5%(64/104)。进一步根据m-YPAS评分将患儿分为高度焦虑组(>40分,64例)和低度焦虑组(≤40分,40例)。单因素分析结果显示,两组间患儿年龄(低龄)、非深Ⅱ度烧伤、烧伤面积(大)、术前心率(快)、被调查者年龄(低)、被调查者特质和状态焦虑评分(高)是烧伤患儿术前焦虑的危险因素(P值均<0.05)。多因素logistic回归分析结果显示,患儿性别(女性)(OR=3.183, 95%CI为1.028~9.857,P=0.045)、非深Ⅱ度烧伤(OR=11.739, 95%CI为3.717~37.077,P<0.001)、患儿年龄(低龄)(OR=0.803, 95%CI为0.684~0.943,P=0.00Objective To investigate the risk factors associated with preoperative anxiety and postoperative pain in children undergoing burn surgery,and their correlation.Methods A prospective study was conducted on 104 children aged 1 to 14 years who underwent burn surgery at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from September 2019 to March 2021.Demographic data including age,gender,residence,and annual family income of both the children and parents were collected before surgery.Trait/state anxiety questionnaires were completed by the parents.The modified Yale Preoperative Anxiety Scale(m-YPAS)was used to assess the anxiety level of the children upon entering the operating room.Clinical data such as burn area,burn depth,preoperative burn time,surgical method,surgical area,preoperative heart rate,and total amount of sufentanil administered during the operation were recorded.Behavioral Pain Scale and Wong-Baker Facial Expression Pain Scale were used to evaluate the pain in the postanesthesia care unit(PACU),and at 4 h,24 h,48 h,and 72 h after anesthesia.The presence or absence of remedial analgesia in PACU along with total amount of remedial analgesic drugs were also documented.Two independent sample T test or two independent sample rank sum test was employed for group comparisons.Variables with P<0.15 in univariate analysis were included in multivariate logistic regression analysis to determine independent risk factors for preoperative anxiety and postoperative pain in pediatric patients.The Spearman test was used to evaluate correlations between preoperative anxiety and postoperative pain among children with burns.Results There were 60 children aged 1 to 3 years old and 44 children aged 4 to 14 years old.The preoperative m-YPAS score in the children aged 1 to 3 years old was significantly higher than that in the children aged 4 to 14 years old([60.76±23.22]vs.[39.49±18.29],χ^(2)=5.418,P<0.001).The incidence of high preoperative anxiety in burn children was 61.5%(64/104).There were 64 children

关 键 词：儿童 烧伤 术前焦虑 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学]