【作者】 刘萍；

【导师】 娄小平；

【作者基本信息】 郑州大学 ， 护理学， 2022， 硕士

【摘要】 目的1.制定针对学龄前斜视患儿术前焦虑、苏醒期躁动的干预方案。2.评价该干预方案对降低学龄前斜视患儿术前焦虑、苏醒期躁动的应用效果。方法1.本实验为类试验研究,选取2021年5月至2021年8月在郑州市某三甲医院全麻下行斜视手术的87例学龄前患儿作为研究对象。抽签法分为干预组(n=43例)和对照组(n=44例),两组患儿及家属均知情同意并自愿参与本研究。对照组以常规方式实施围术期管理,干预组在此基础上实施童趣化干预措施,主要包括童趣化互动、童趣化引导、童趣化复苏。2.在术前访视、麻醉诱导时、术后一天,采用“中文版改良耶鲁术前焦虑量表”、“小儿麻醉苏醒期躁动评分”、“术后行为量表”,测量患儿术前焦虑水平、术后苏醒期躁动情况和术后行为改变情况。同时监测患儿入恢复室(Postanesthesia Care Unit,PACU)、拔气管导管时、拔气管导管后5min的平均动脉压(Mean Arterial Pressure,MAP)和心率(Heart Rate,HR),记录患儿在PACU停留时间。3.SPSS 26.0统计软件对资料进行统计分析。连续性变量采用均数±标准差((?)±s)描述;分类变量采用率和构成比描述;不同时间点的变量用重复方差分析,存在交互效应时,采用基于局部调整标准误的配对t检验进行单独效应分析;连续性变量的组间比较采用独立样本t检验,分类变量的组间比较采用卡方检验;检验水准α=0.05,双侧P值<0.05表示差异有统计学意义。结果本研究共失访3例,对照组1例,干预组2例,最终共有效的干预为87例,包括干预组43例,对照组44例。1.两组患儿的一般社会人口学情况(年龄、性别、爱好特长)和疾病相关资料(手术部位、手术的时间、输液量)等基线资料比较差异无统计学意义(P>0.05)。2.两组患儿术前焦虑量表比较:干预组在术前访视时焦虑评分为(27.07±10.01),对照组为(26.50±10.57),两组在访视时焦虑评分无统计学意义(P>0.05);干预组在入手术室时焦虑评分为(35.68±7.35),对照组为(51.21±15.55),两组在入手术时的焦虑评分差异有统计学意义(P<0.01)。3.两组患儿苏醒期躁动评分和发生躁动的例数比较:干预组苏醒躁动评分为(3.19±2.14),对照组为(9.23±4.77),两组相比有统计学意义(P<0.01);干预组发生躁动例数为1,比例为2.3%,对照组为18,比例为40.9%,两组相比差异有统计学意义(P<0.01)。4.两组患儿各时间点MAP存在时间效应(F时间效应=39.45,P<0.01),即MAP随时间变化而变化,但不存在分组效应(F组间效应=0.67,P>0.05),即两组患儿间MAP差异没有统计学意义。组间比较:两组患儿MAP在入PACU、拔管时和拔管后5min均无统计学意义(P>0.05);组内比较:两组患儿入PACU时MAP显著低于拔管时和拔管5min(P<0.01),而拔管时与拔管5min时的MAP的差异无统计学意义(P>0.05)。5.两组患儿各个时间点间的HR存在时间分组的交互效应(F交互效应=5.77,P<0.05),因此进行了单独效应分析。组间比较:两组患儿HR在入PACU时差异无统计学意义(P>0.05),对照组HR在拔管时和拔管5min显著高于干预组(P<0.05);组内比较:拔管时HR明显高于入PACU时和拔管后5min(P<0.05)。6.两组患儿在PACU的停留时间比较:干预组的停留时间为(33.09±5.40)min,对照组的停留时间为(39.32±6.61)min,两组相比有统计学意义(t=4.80,P<0.01)。7.两组患儿术后行为改变率比较:干预组术后行为改变率为16%,对照组术后行为改变率为34%,两组相比有统计学意义(P<0.01)。结论童趣化干预可有效缓解患儿入手术室时的焦虑情绪,减少苏醒期躁动和术后行为改变的发生,缩短PACU停留时间。更多还原

【Abstract】 Objective1.To formulate the playful intervention for preoperative anxiety and restl essness in the recovery period of preschool children with strabismus.2.To evaluate the effect of this intervention program on reducing preoperative anxiety and restlessness in awakening period in preschool children with strabismus.Methods1.This experiment is a kind of experimental study.87 preschool children with strabismus undergoing elective surgery under general anesthesia in a third class hospital in Zhengzhou from May 2021 to August 2021 were selected as the research objects.The patients were randomly divided into intervention group(n = 43 cases)and control group(n = 44 cases).The children and their families in the two groups had informed consent and voluntarily participated in the study.The control group implemented perioperative management in the way of routine guidance,and the intervention group implemented playful intervention on this basis,including playful interaction,playful guidance,playful recovery.2.During the preoperative visit,when children are inducedand one day after the operation,the " Chinese Version of the Modified Yale Preoperative Anxiety Scale"," Pediatric Anesthesia Emergence Delirium Scale" and " Post Hospitalization Behavior Questionnaire" were used to measure the children’s preoperative anxiety level,restlessness in the recovery period and postoperative behavior changes.At the same time,the mean arterial pressure and heart rate of children entering the recovery room,extubation and 5 minutes after extubation were monitored,and the residence time in the recovery room and the incidence of adverse events were recorded.3.SPSS 26.0 statistical software carries out statistical analysis on the data.Continuous variables are described by(x±s);Description of adoption rate and component ratio of classified variables;The variables at different time points were analyzed by repeated measurement of variance analysis.When there were interaction effects,the paired t-test based on local adjusted standard error was used to analyze the individual effects;Independent sample t-test was used for the comparison between groups of continuous variables,and chi square test was used for the comparison between groups of classified variables;Inspection level α=0.05,P<0.05 means the difference is statistically significant.ResultsIn this study,there were 3 cases of lost follow-up,1 case in the control group and2 cases in the intervention group.Finally,there were 87 cases of effective intervention,the intervention group include 43 cases and the control group 44 cases.1.The two groups has no significant difference in baseline data,such as general socio-demographic situation(age,gender,education level)and disease-related data(surgical site,surgical time,infusion volume)(P > 0.05).2.The preoperative anxiety scale between the two groups: the anxiety score of the intervention group was(27.07±10.01)and that of the control group was(26.50±10.57),and there was no statistical significance in the anxiety score of the two groups at the visit(P<0.05);The anxiety score of the intervention group was35.68±7.35,and that of the control group was(51.21±15.55).The difference was statistically significant in anxiety scores between the two groups(P<0.01).3.The results showed that the resuscitation agitation score in the intervention group was(3.19±2.14),and the resuscitation agitation score in the control group was(9.23±4.77),which was statistically significant(P<0.01);The incidence of agitation was 1(2.3%)in the intervention group and 18(40.9%)in the control group,the difference between the two groups was statistically significant(P<0.01).4.There was a time effect on map at each time point in the two groups(F=39.45,P<0.01),that is,map changed with time;However,there was no grouping effect(F=0.67,P>0.05),that is,there was no significant difference in map between the two groups.Comparison between groups: there was no significant difference in map between the two groups in PACU,extubation and 5min after extubation(P>0.05);Intra group comparison: the map of the two groups at PACU was significantly lower than that at extubation and 5min(P<0.01),but there was no significant difference between the map at extubation and 5min(P>0.05).5.The HR of the two groups at each time point had the interaction effect of time grouping(F=5.77,P<0.05),so a separate effect analysis was conducted.Comparison between groups: there was no significant difference in HR between the two groups when they entered PACU(P>0.05).HR in the control group was significantly higher than that in the intervention group(P<0.05);Intra group comparison: HR at extubation was significantly higher than that at PACU and 5min after extubation(P<0.05).6.Comparison of the stay time in PACU between the two groups: the stay time in PACU in the intervention group was(33.09±5.40)min,and the stay time in PACU in the control group was(39.32±6.61)min,which was statistically significant(t=4.80,P< 0.01).7.Comparison of postoperative behavior change rate and incidence of postoperative adverse events between the two groups: the postoperative behavior change rate of the intervention group was 16%,and the postoperative behavior change rate of the control group was 34%,which was statistically significant(P< 0.01).ConclusionPlayful intervention can effectively alleviate the anxiety of children when entering the operating room,reduce the occurrence of restlessness during awakening and postoperative behavioral changes,and shorten the stay time of PACU.更多还原