小儿骨科围手术期的心理干预

The application of psychological intervention in the orthopaedics perioperative period

目的探讨围术期针对骨科患儿及其家长施行心理干预，对手术满意度的影响。方法选择学龄期（6-10岁）择期手术患儿52例及其父母为研究对象，术前随机分为两组，实验组27例，对照组25例。均实施气管插管全身麻醉。对实验组患儿及其父母在术前及术后进行心理指导。对照组不采取干预措施。干预后用临床精神卫生症状自评量表（SCL —90）对两组患儿父母心理状况进行评估，对术前访视（T1）、入手术室（T2）、全麻插管诱导时（T3）、术后24 h（T4）四个时间点两组患儿的焦虑水平用改良耶鲁围术期焦虑量表（mYPAS）评估、同时在 T3时间点用诱导期合作度量表（ICC）评估患儿合作程度[1，2]。结果实验组患儿父母围术期 SCL —90评分低于对照组，与 T1时间点比较，两组患儿mYPAS 在 T2及 T3两个时间点焦虑评分明显升高（P ＜0．05）；与对照组比较，实验组患儿在 T3时其焦虑评分明显降低（P ＜0．05），同时合作评分也明显降低（P ＜0．05）；T4时间点上两组得分均高于 T1时间点，同时实验组 T4得分值低于对照组 T4得分值。结论①对学龄期患儿采用心理干预可有效消除患儿对麻醉及手术的负面心理影响，提高对围手术期的依从性；②对患儿父母采用心理干预会降低其焦虑水平，有效帮助患儿减轻围手术期心理障碍；③以上两种情况都可提高手术满意度。

Objetive To explore the effect of surgical satisfaction by implementing psychological inter-vention on orthopedic pediatric patients and their parents.Methods 52 cases of optional operative school-age children （6 -10 years old）and their parents.Randomly divided into two groups before the surgery,experimen-tal group （N=27）,control group （N=25）.Both groups implementing general anesthesia endotracheal intuba-tion.Implementing psychological guidance to experimental groups around the surgery but not to control groups. Using the Clinical symptoms of mental health self-rating scale （SCL -90）to assessment the two groups par-ents’s mental condition after the intervention.Using the modified yale preoperative anxiety scale（mYPAS）to assessment the two groups of children ＇s anxiety level at four times（T1：Preoperative visit time ,T2：Into the op-erating room time ,T3：General anesthesia endotracheal intubation induction time,T4：24 h after surgery）.As-sessment the children ＇s cooperation by using the Induction period of cooperation Scale （ICC）at the T3. Re-sults The experiment group parent SCL -90 scores below the control group.compared to T1,both of the two groups children scores have increased significantly（P 〈0.05）,compared during the experiment group and the control group,the former group scores of anxiety was below significantly（P 〈0.05 ）,at the same time,ICC scores was below.two groups patients scores were high compared to T1 （P 〈0.05）. Conclusion ①Psycho-logical treatments in the preoperative period of school-age children elevate effectively anxiety perioperation and negative emotions to enhance perfect induction.②Psychological treatments in the preoperative period of parents have helped children through psychological barrier.③They can improve the surgical satisfaction.