黃偉妮,劉安林,彭新明,黃波,彭艷梅
(廣州醫(yī)學院附屬深圳沙井醫(yī)院麻醉科,廣東深圳518104)
全麻誘導期家長陪同對小兒與家長心理焦慮的緩解作用
黃偉妮,劉安林,彭新明,黃波,彭艷梅
(廣州醫(yī)學院附屬深圳沙井醫(yī)院麻醉科,廣東深圳518104)
目的觀察家長陪同緩解全麻誘導期小兒與家長心理焦慮的狀況。方法249對患兒與家長隨機分為三組各83例,對照組常規(guī)術前護理,觀察組常規(guī)護理并由家長陪同,藥物組常規(guī)護理并口服咪達唑侖。記錄麻醉誘導前患兒與家長心理焦慮評分。結果觀察組和藥物組患兒的焦慮評分均明顯低于對照組(P<0.05);藥物組患兒的焦慮評分均明顯低于觀察組(P<0.01)。觀察組家長的焦慮評分低于其他家長,差異有統(tǒng)計學意義(P<0.01)。結論家長陪同可緩解全麻誘導期小兒與家長的心理焦慮。
家長陪同;麻醉;焦慮
兒童術前焦慮與術后不良反應相關[1],并增加術后不良行為的發(fā)生[2]。多數(shù)家長在患兒術前焦慮明顯增加,這也加重患兒的心理焦慮[3]。全麻誘導期家長陪同可減輕患兒與家長術前的焦慮心理[4],現(xiàn)將我院2009年6月至2012年12月的實施結果報道如下:
1.1 一般資料選擇249例ASAⅠ~Ⅱ級擬全麻患兒,年齡3~9歲,排除早產(chǎn)兒和慢性病史者,隨機分為三組各83例,對照組常規(guī)術前護理,觀察組常規(guī)護理并由家長陪同,藥物組常規(guī)護理并麻醉前30 min口服咪達唑侖0.5 mg/kg,記錄麻醉誘導前患兒與家長的焦慮評分。藥物組:男性40例,女性43例,年齡(5.2±2)歲;觀察組:男性46例,女性37例,年齡(5.4± 2)歲;對照組:男性41例,女性42例,年齡(5.4±2)歲。三組患者性別、年齡和手術種類差異無統(tǒng)計學意義。
1.2 觀察指標和評分標準記錄麻醉誘導前患兒與家長的焦慮評分。小兒心理焦慮采用改良耶魯術前焦慮評分(mYPAS)[5]。mYPAS常用于評價l歲以上兒童的焦慮狀況,綜合分值為21~100分,評分越高表明焦慮越明顯。家長心理焦慮采用State-Trait Anxiety Inventory(STAI)[6]評估。
1.3 統(tǒng)計學處理數(shù)據(jù)以均數(shù)±標準差(x-±s)表示,采用SPSS10.0統(tǒng)計軟件,組間計量資料的比較采用t檢驗,以P<0.05為差異有統(tǒng)計學意義。
藥物組和觀察組患兒的焦慮評分均明顯低于對照組(P<0.05);藥物組患兒的焦慮評分均明顯低于觀察組(P<0.05)。觀察組家長的焦慮評分低于其他家長,差異有統(tǒng)計學意義(P<0.05),見表1。
表1 三組患兒與家長焦慮評分的比較(分)
表1 三組患兒與家長焦慮評分的比較(分)
注:小兒:藥物組vs對照組,t=4.319,P<0.05;觀察組vs對照組,t= 2.100,P<0.05;藥物組vs觀察組,t=2.030,P<0.05。家長:藥物組vs對照組,t=0.9956,P>0.05;觀察組vs對照組,t=3.782,P<0.050;藥物組vs觀察組,t=2.6920,P<0.05。
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手術室是特殊醫(yī)療環(huán)境,患兒突然進入并與父母分離會產(chǎn)生強烈的分離焦慮,他們產(chǎn)生的心理影響遠遠超過了對手術麻醉的恐懼[7]。圍術期家長心理焦慮也越來越受重視[3]。減少患兒與家長術前焦慮是手術室優(yōu)質(zhì)護理的重要方面。
術前使用神經(jīng)安定類藥物可降低患兒焦慮水平,但存在醫(yī)療費用增加、延遲蘇醒和降低短時間手術周轉率等問題,而且無法解決家長的焦慮問題。全麻誘導期家長陪同的優(yōu)點已得到臨床證實[1],本研究發(fā)現(xiàn),全麻誘導期家長陪同與術前口服咪達唑侖均可降低患兒的焦慮水平,前者同時降低家長的焦慮水平,而后者無明顯效果。因此全麻誘導期家長陪同更適合作為圍術期優(yōu)質(zhì)護理的標準,可同時減少患兒與家長的心理焦慮,并提高家長對圍術期護理質(zhì)量的滿意度。
[1]Kain ZN,Caldwell-Andrews AA,Maranets I,et al.Preoperative anxiety,emergence delirium and postoperative maladaptive behaviors:Are they related?A new conceptual framework[J].Anesth Analg,2004,99:1648-1654.
[2]Kain ZN.Postoperative maladaptive behavioral changes in children: Incidence risks factors and interventions[J].Acta Anaesthesiol Belg,2000,51:217-226.
[3]Caldwell-Andrews A,Kain Z,Mayes L,et al.Motivation and maternal presence during induction of anesthesia[J].Anesthesiology, 2005,103:478-483.
[4]李梅,范雪梅,李天佐.兒童圍術期焦慮及心理干預的探討[J].北京醫(yī)學,2008,30(11):676-678.
[5]Kain Z,Mayes L.The Yale Preoperative Anxiety Scale:How does it compare to a gold standard?[J].AnesthAnalg,1997,85:783-788.
[6]Spielberger CD.Manual for the State-Trait Anxiety Inventory (STAI:FormY)[M].Palo Alto,California:Consulting Psychologists Press,1983:4-26.
[7]石蘭萍,李少蘭,陳金玉,等.小兒麻醉誘導期家長陪同的護理探討[J].實用護理雜志,2003,19(4):36.
Parental presence relieve anxiety of children and parents during induction of general anesthesia.
HUANG Wei-ni,LIU An-lin,PENG Xin-ming,HUANG Bo,PENG Yan-mei.Shenzhen Shajing Affiliated Hospital to Guangzhou Medical University,Shenzhen 518104,Guangdong,CHINA
ObjectiveTo observe the effect of parental presence on anxiety relieve for children and their parents during induction of general anesthesia.MethodsA total of 249 pairs of children(ASAⅠ~Ⅱ)and their parents were randomly assigned to three groups:control group(group C):
standard of care;parental presence group(group B):received parental presence during induction of anesthesia;and oral midazolam(group A).Anxiety levels were recorded before anesthesia.ResultChildren in group A(P<0.01)and group B(P<0.05)exhibited significantly lower anxiety as compared with group C.Children in group A were less anxious during induction of anesthesia as compared with group B(P<0.05).Parents in group B were less anxious than others.ConclusionParental presence is effective in the reduction of preoperative anxiety.
Parental presence;Anestheisa;Nursing;Anxiety
R614.2
A
1003—6350(2013)19—2920—02
10.3969/j.issn.1003-6350.2013.19.1217
2013-03-29)
廣東省深圳市寶安區(qū)科技局立項(編號:2009424)
黃偉妮。E-mail:214458232@qq.com