术前动画视频陪伴改善学龄前儿童分离焦虑及诱导配合的临床观察

Preoperative video distraction alleviates separation anxiety and improves induction compliance of preschool children:a randomized controlled clinical trial

目的探究动画视频陪伴对全身麻醉(全麻)下行斜视矫正手术的学龄前儿童术前分离焦虑和麻醉诱导配合度的影响。方法该研究为前瞻性随机对照研究,选取2019年9月1日至12月31日在首都医科大学附属北京同仁医院择期吸入麻醉下行斜视矫正术的患儿80例,年龄3-6岁,随机数字表法分为常规组和视频组,每组40例。视频组患儿自术前等候、与父母分离至麻醉诱导意识消失过程持续观看动画视频,常规组患儿该过程中无视频陪伴。记录两组患儿进入等候区即刻(T1)、与父母分离时(T2)改良耶鲁围术期焦虑量表(mYPAS)评分,麻醉诱导时记录诱导合作量表(ICC)评分,麻醉恢复室(PACU)观察期间记录苏醒时间,恶心呕吐、喉痉挛、严重咳嗽、低氧血症、窦性心动过缓等不良反应。术后第1天随访记录疼痛、头晕、恶心呕吐、嗜睡等术后不良反应,并进行患儿家长麻醉满意度评分。结果T1时,两组患儿mYPAS评分及mYPAS评分>30分的比例差异均无统计学意义(P>0.05)。T2时,视频组患儿mYPAS评分和mYPAS评分>30分的比例分别为(34.41±13.23)分和52.50%,低于常规组患儿的(50.64±20.96)和87.50%,差异有统计学意义(均P<0.05)。视频组ICC评分为(1.83±2.26)分,低于常规组的(4.03±2.99)分,差异有统计学意义(P<0.05)。视频组ICC=0比例为37.50%,高于常规组12.50%,而ICC=4-10比例为17.50%,低于常规组45.00%,差异有统计学意义(P<0.05)。苏醒时间、PACU及术后不良反应发生率两组间比较差异均无统计学意义(均P>0.05)。视频组家长麻醉满意度评分为(9.23±0.89)分,高于常规组的(8.63±1.23)分,差异有统计学意义(P<0.05)。结论术前动画视频陪伴能够减轻全麻下行斜视矫正手术的学龄前儿童术前分离焦虑,改善吸入麻醉诱导配合度,提高患儿家属满意度。

Objective To explore the effect of video distraction on preoperative separation anxiety and induction compliance of preschool children receiving strabismus surgery under general anesthesia.Methods In this prospective trial,80 children aged 3 to 6 years scheduled for strabismus surgery under inhalation anesthesia were randomly allocated to one of two groups,a control group and a video distraction group,with 40 cases in each group.Children in the video distraction group continuously watched videos from waiting in the holding area,separating with parents,entering the operating room and induction of anesthesia,while children in the control group didn′t watch videos during the same process.The modified Yale Preoperative Anxiety Scale(mYPAS)of children were recorded upon arriving at the holding area(T1)and separating with parents(T2).Induction Compliance Checklist(ICC)score was recorded when the anesthesia induction was performed.The emergence time,the occurrence rate of adverse events in post-anesthesia care unit(PACU)including nausea and vomiting,laryngospasm,severe cough,hypoxemia and sinus bradycardia,incidence of postoperative adverse reactions such as pain,dizziness,nausea and vomiting and lethargy,the parents′satisfaction of anesthesia were also assessed.Results There were no significant difference in mYPAS score and the proportion of mYPAS score>30 between 2 groups at T1(all P>0.05).At T2,the mYPAS score and the proportion of mYPAS score>30 in video distraction group were(34.41±13.23)and 52.50%,which were lower than those in control group(50.64±20.96,87.50%)with statistically significant difference(all P<0.05).The ICC score of video distraction group was lower than that of the control group,which was(1.83±2.26)vs(4.03±2.99),and the difference was statistically significant(P<0.05).The proportion of children with ICC score=0 in video distraction group was 37.50%,which was higher than that in the control group(12.50%),while the proportion of children with ICC score=4-10 was lower than that of the control group,which was 17.50%vs 45.00%,and the difference was statistically significant(P<0.05).No significant intergroup differences were observed in emergence time,incidence of adverse events in PACU,and incidence of postoperative adverse reactions(P>0.05).The parents′satisfaction of anesthesia in the video distraction group was(9.23±0.89),which was higher than that in the control group(8.63±1.23),with statistically significant(P<0.05).Conclusion Preoperative video distraction alleviates separation anxiety,improves induction compliance of preschool children receiving strabismus surgery under general anesthesia,and increases the parents′satisfaction of anesthesia.