舒适化护理对日间手术儿童术前焦虑和术后早期转归的影响

吴新雁; 韩丁; 王煜; 陈梅丽; 杨学静; 潘守东

doi:10.16766/j.cnki.issn.1674-4152.002792

舒适化护理对日间手术儿童术前焦虑和术后早期转归的影响

doi: 10.16766/j.cnki.issn.1674-4152.002792

1.
首都儿科研究所附属儿童医院麻醉科，北京 100020
2.
首都儿科研究所附属儿童医院护理部
3.
首都儿科研究所附属儿童医院社会工作部

基金项目:

首都临床特色应用研究项目 Z181100001718096

首都儿科研究所青年课题基金 QN-2020-05

详细信息

通讯作者:
潘守东，E-mail：panshoudong@shouer.com.cn

中图分类号: R473.72 R726.1
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- 文章访问数: 245
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- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-11
- 网络出版日期: 2023-02-07

Effects of comfort nursing on preoperative anxiety and postoperative early outcomes in children undergoing day surgery

1.
Department of Anesthesia, Children ' s Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China

摘要

摘要: 目的探讨舒适化护理对日间手术儿童术前焦虑和术后早期转归的影响。方法选取2020年1—12月于首都儿科研究所附属儿童医院接受日间手术治疗的1~14岁儿童共451例，根据随机数字表法分为对照组(227例)和观察组(224例)。对照组采取常规护理，观察组采取舒适化护理。采用改良耶鲁术前焦虑评分(mYPAS)评价患儿的术前焦虑水平；对儿童麻醉苏醒期躁动进行评分并计算苏醒期躁动(>12分)发生率；术后3 d通过电话随访，采用住院后行为问卷调查患儿不良行为发生率，以及调查家长对医疗护理服务的满意度评分分级。结果观察组与对照组相比，mYPAS[5.0(5.0，7.0)分vs. 10.0(8.0, 15.0)分]、苏醒期躁动[23例(10.3%) vs. 101例(44.5%)]和术后不良行为改变[5例(2.2%) vs. 40例(17.6%)]均显著降低(均P＜0.05)，家长满意度分级更优(P＜0.05)。结论舒适化护理可有效缓解日间手术患儿术前焦虑，降低麻醉苏醒期躁动和术后不良行为改变的发生率，适于在儿童日间手术中心普及推广。
- 舒适化护理 /
- 儿童 /
- 术前焦虑 /
- 苏醒期躁动 /
- 术后行为改变
Abstract: Objective To explore the effects of comfort nursing on preoperative anxiety and postoperative early outcomes in children having day surgery. Methods A total of 451 children aged 1-14 years old and undergoing day surgery at Children ' s Hospital Affiliated to Capital Institute of Pediatrics from January 2020 to December 2020 were enrolled, and they were randomly divided into the control (n=227) and observation (n=224) groups based on the random number table method. The control group was subjected to standard nursing. The observation group received comfort nursing. The preoperative anxiety level of children was assessed with modified Yale preoperative anxiety scale (mYPAS). The post-anaesthesia emergence agitation score was determined, and the rate of post-anesthesia emergence delirium (those with a score > 12 points) was calculated. Three days after surgery, a telephone follow-up was conducted to investigate the incidence of negative behaviour change in the children with post-hospitalisation behaviour questionnaire and to investigate the satisfaction grade of parents with medical care services. Results Compared with the control group, the mYPAS score [5.0 (5.0, 7.0) points versus 10.0 (8.0, 15.0) points], incidence of agitation during recovery [23 (10.3%) versus 101 (44.5%)] and incidence of postoperative adverse behaviour change [5 (2.2%) versus 40 (17.6%)] significantly decreased (all P < 0.05) in the observation group, and the satisfaction grade of parents was better (P < 0.05). Conclusion Comfort nursing is effective in relieving preoperative anxiety and reducing the incidence of anaesthesia emergence agitation and negative postoperative behaviour changes in children undergoing day surgery, and should be popularised in children ' s day surgery centres.
- Comfort nursing /
- Children /
- Preoperative anxiety /
- Post-anesthesia emergence delirium /
- Postoperative behavior change

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表 1 2组择期手术治疗患儿一般资料比较

Table 1. Comparison of general data between the two groups of children with elective surgery

组别	例数	年龄(x±s，岁)	体重(x±s，kg)	性别(男/女，例)	手术方式(例)
组别	例数	年龄(x±s，岁)	体重(x±s，kg)	性别(男/女，例)	腹腔镜下鞘状突高位结扎术	腹腔镜下腹股沟斜疝修补术	鼻内镜下腺样体消融术	包皮环切术	其他^c
对照组	227	4.7±2.6	20.6±10.5	194/33	86	68	34	26	13
观察组	224	4.6±2.6	20.7±11.3	202/22	112	45	32	25	10
统计量		0.628^a	0.038^a	2.342^b			8.547^b
P值		0.530	0.970	0.126			0.073
注：^a为t值，^b为χ²值；^c其他包括鼻骨骨折、慢性阑尾炎、先天性附耳、耳内异物、皮脂腺囊肿、头皮肿物手术。

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表 2 2组择期手术治疗患儿术前焦虑、PAED和术后不良行为改变情况比较

Table 2. Comparison of preoperative anxiety, PAED and postoperative adverse behavior changes between the two groups

组别	例数	mYPAS评分[M(P₂₅, P₇₅)，分]	PAED发生[例(%)]	术后不良行为改变发生[例(%)]
对照组	227	10.0(8.0，15.0)	101(44.5)	40(17.6)
观察组	224	5.0(5.0，7.0)	23(10.3)	5(2.2)
统计量		14.345^a	66.249^b	29.726^b
P值		< 0.001	< 0.001	< 0.001
注：^a为Z值，^b为χ²值。

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表 3 2组择期手术治疗患儿家长对医疗护理服务的满意情况比较[人(%)]

Table 3. Comparison of parents' satisfaction with medical care service between the two groups[cases(%)]

组别	人数	满意	基本满意	不满意
对照组	227	77(33.92)	130(57.27)	20(8.81)
观察组	224	110(49.10)	105(46.88)	9(4.02)
注：2组满意情况比较，Z=3.398，P=0.001。

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