遮眼预处理对学龄前期儿童全身麻醉术后急性谵妄影响的单双眼应用效果评价

A comparison of binocular and monocular surgery on the effect of eye-covering pretreatment on emergence delirium after general anesthesia in pre-school aged children

目的评价遮眼预处理对单或双眼手术的学龄前期儿童全身麻醉(简称全麻)术后急性谵妄发生的影响。方法选取2019年8月至2021年2月在浙江大学医学院附属第二医院择期行眼科全麻手术的学龄前期患儿300例为研究对象,采用随机数字表法分为对照组和遮眼组各150例。对照组患儿在术前进行动画视频常规健康教育,遮眼组患儿在动画视频健康教育基础上结合遮眼预处理(单眼手术行单眼遮盖,双眼手术行双眼遮盖)。比较2组改良耶鲁术前焦虑量表(m-YPAS)、术后谵妄量表(NU-DESC)、谵妄发生率和术后护理照护难度评分,并对遮眼组的单双眼进行亚组比较。结果最终完成本次研究271例,遮眼组129例(单眼手术66例,双眼手术63例),对照组142例(单眼手术73例,双眼手术69例)。遮眼组患儿的术前m-YPAS评分、术后NU-DESC评分及急性谵妄发生率、术后护理照护难度评分中,单眼手术分别为(40.28±15.02)分、1.00(0.00,2.00)分、27.3%(18/66)、1.00(1.00,2.00)分,双眼手术分别为(41.69±16.35)分、1.00(0.00,2.00)分、39.7%(25/63)、1.00(1.00,2.00)分;对照组单眼手术分别为(46.28±15.76)分、2.00(1.00,3.00)分、67.1%(49/73)、2.00(1.00,3.00)分,双眼手术分别为(47.77±14.82)分、3.00(2.00,4.00)分、82.6%(57/69)、2.00(1.50,3.00)分。2组比较差异有统计学意义(t=-2.29、-2.24,Z值为-5.74~-2.95,χ^(2)=32.94、25.78,均P<0.05)。遮眼组单及双眼的术前m-YPAS评分、术后NU-DESC评分及急性谵妄发生率、术后护理照护难度评分比较差异无统计学意义(均P>0.05)。结论单或双眼遮眼预处理均能有效降低全麻手术患儿的术前m-YPAS评分、术后NU-DESC评分、急性谵妄发生率及术后护理照护难度。单或双眼的应用效果比较无差异。

Objective To evaluate the effect of eye-covering pretreatment on acute delirium in ophthalmology preschool-age children who underwent binocular and monocular surgery by general anesthesia.Methods The 300 preschool-age children who underwent general anesthesia of elective ophthalmic surgery in the Second Affiliated Hospital,Zhejiang University School of Medicine,from August 2019 to February 2021 were selected as the research object.They were divided into control group and blindfold group with 150 cases each by random number-table.Children in the control group received regular education on cartoon animation videos before surgery;children in the blindfold group received eye-covering pretreatment on the basis of cartoon animation videos(monocular surgery with monocular cover,binocular surgery with binocular cover).The Modified Yale Preoperative Anxiety Scale(m-YPAS),the Nursing Delirium Screening Scale(NU-DESC),the incidence rate of delirium and the score of postoperative nursing difficulty were compared between two groups.Results The 271 cases were completed in this study,including 129 cases(monocular surgery 66 cases,binocular surgery 63 cases)in the blindfold group and 142 cases(monocular surgery 73 cases,binocular surgery 69 cases)in the control group.The preoperative m-YPAS score,the postoperative NU-DESC score,the incidence rate of acute delirium and postoperative nursing care difficulty score of monocular surgery in the blindfold group,monocular surgery was(40.28±15.02)points,1.00(0.00,2.00)points,27.3%(18/66),1.00(1.00,2.00)points,and binocular surgery was(41.69±16.35)points,1.00(0.00,2.00),39.7%(25/63),1.00(1.00,2.00);in the control group,monocular surgery was(46.28±15.76)points,2.00(1.00,3.00)points,67.1%(49/73),2.00(1.00,3.00)points,and binocular surgery was(47.77±14.82)points,3.00(2.00,4.00)points,82.6%(57/69)and 2.00(1.50,3.00)points respectively.The difference between the two groups was statistically significant(t=-2.29,-2.24,Z values were-5.74--2.95,χ^(2)=32.94,25.78,all P<0.05).The preoperative m-YPAS score,the postoperative NU-DESC score,the incidence rate of acute delirium and postoperative nursing care difficulty score of monocular surgery patients in the blindfold group had no significantly statistical difference with that of binocular surgery patient(all P>0.05).Conclusions Monocular/binocular eye-covering pretreatment can effectively decrease the preoperative m-YPAS score,the postoperative NU-DESC score,incidence rate of acute delirium and the postoperative nursing care difficulty in preschool-age children who underwent general anesthesia both monocular or binocular surgery.There was no difference in the application effect of monocular or binocular surgery.