儿童医疗辅导模式术前访视在学龄前患儿焦虑情绪管理中的应用研究

Preoperative interview mode with Child Life in the management of preschool children's anxiety

目的探讨儿童医疗辅导(Child Life)模式术前访视在学龄前患儿焦虑情绪管理中的应用效果。方法采用方便抽样法,选择2018年9月至2019年2月手术的80例学龄前期患儿为研究对象,2018年9—11月实施传统模式术前访视的患儿设为对照组;2018年12月至2019年2月实施Child Life模式术前访视的患儿设为试验组。比较2组患儿围手术期4个不同时间点(入院6 h、等待手术时、麻醉诱导时、术后6 h)的改良耶鲁围手术期焦虑量表(m-YPAS)评分、诱导期合作量表(ICC)评分以及苏醒期躁动评分量表(PAED)评分。结果3例因手术暂停退出研究,共77例患儿完成研究,试验组38例、对照组39例。在等待手术时试验组的m-YPAS评分为(17.57±16.64)分,低于对照组的(42.04±27.46)分,差异有统计学意义(t值为3.85,P<0.01);在麻醉诱导时m-YPAS评分(31.64±27.95)分,低于对照组的(62.22±25.13)分,差异有统计学意义(t值为4.26,P<0.01);入院6 h和术后6 h的m-YPAS评分试验组为(18.19±17.83)、(35.61±15.70)分,对照组为(19.85±17.92)、(41.81±17.97)分,2组间比较差异无统计学意义(t值为0.87、1.37,P>0.05)。2组患儿均在麻醉诱导时完成ICC评分,试验组(1.40±1.39)分,低于对照组的(3.78±2.60)分,差异有统计学意义(t值为4.88,P<0.01);2组患儿均在麻醉苏醒后完成PAED评分,试验组(7.18±2.45)分、对照组(7.85±3.05)分,2组间比较差异无统计学意义(t值为0.91,P>0.05)。结论与传统术前访视模式比较,Child Life模式术前访视能有效缓解学龄前期全身麻醉手术患儿在等待手术时和麻醉诱导时手术患儿的焦虑情绪,提高患儿麻醉诱导过程的合作度。

Objective To explore the effect of preoperative visit with Child Life mode in the management of preschool children's anxiety.Methods A total of 80 cases of children of pre-school age who were operated from September 2018 to February 2019 were selected by cluster sampling method.The children from September to November 2018 who were given the traditional mode of preoperative visit were set as the control group.Children from December 2018 to February 2019 who were given preoperative visit with Child Life mode were set as the experimental group.The Modified Yale Perioperative Anxiety Scale(m-YPAS)scores,Induction Compliance Checklist(ICC)scores and Pediatric Anesthesia Emergence Delirium(PAED)scores were compared between the two groups at 4 different perioperative time points(6 hours after admission,waiting for surgery,induction of anesthesia,and 6 hours after surgery).Results Totally three patients were suspended from the study due to surgery.A total of 77 children were studied,38 in the experimental group and 39 in the control group.The score of m-YPAS in the experimental group was significantly lower than that of the control group(17.57±16.64 vs.42.04±27.46,t value was 3.85,P<0.01)while waiting for surgery.The score of m-YPAS in the experimental group was significantly lower than control group(31.64±27.95 vs.62.22±25.13,t value was 4.26,P<0.01)at the anesthesia induction.Compare with the control group,the score of m-YPAS in the experimental group showed no significant difference at both time of 6 hours after admission(18.19±17.83 vs.19.85±17.92,t value was 0.87,P>0.05)and 6 hours after surgery(35.61±15.70 vs.41.81±17.97,t value was 1.37,P>0.05).Compare with the control group the score of ICC in the experimental group was significantly decreased(1.40±1.39 vs.3.78±2.60,t value was 4.88,P<0.01)at the anesthesia induction.The score of PEAD in the experimental group and control group,there was no significant difference between the two groups(7.18±2.45 vs.7.85±3.05,t value was 0.91,P>0.05).Conclusions Compared with the traditional preoperative visit mode,the preoperative visit mode of Child Life can effectively relieve the anxiety of preschool children undergoing general anesthesia surgery while they are waiting for surgery and during anesthesia induction,and can improve the degree of cooperation during anesthesia induction.