视觉预适应对学龄前儿童眼科手术麻醉苏醒期躁动的干预效果研究

The effect of visual preconditioning on emergence agitation of preschool children during ophthalmologic anesthesia

目的探讨视觉预适应对学龄前儿童眼科手术麻醉苏醒期躁动的干预效果。方法选取2021年2—9月于山东大学齐鲁医院行眼科择期手术的学龄前患儿156例为研究对象,采用随机数字表法分为对照组和试验组,每组78例。对照组术前1 h给予常规护理,试验组术前1 h通过遮挡术眼进行视觉预适应处理。采用中文版改良耶鲁术前焦虑量表(Cm-YPAS)对患儿麻醉诱导时的焦虑程度进行评分;苏醒期采用小儿麻醉苏醒期谵妄量表(PAED)比较2组患儿的苏醒期躁动评分及躁动发生率。结果最终试验组纳入75例,对照组纳入75例。麻醉诱导时试验组Cm-YPAS得分为(39.78±4.84)分,对照组为(41.07±5.09)分,差异无统计学意义(P>0.05);苏醒期试验组PAED得分为5(4,8)分,低于对照组的8(5,11)分,差异有统计学意义(Z=-3.07,P<0.01)。试验组苏醒期躁动发生率为14.67%(11/75),低于对照组的38.67%(29/75),差异有统计学意义(χ^(2)=11.05,P<0.01)。结论视觉预适应能有效提高眼科学龄前患儿全身麻醉手术的苏醒质量,降低苏醒期躁动的发生率,值得临床推广应用。

Objective To investigate the effect of visual preconditioning on emergence agitation in ophthalmic surgery among preschool children.Methods A total of 156 preschool children who underwent elective ophthalmic surgery in Qilu Hospital of Shandong University from February to September 2021 were selected as the research subjects,and they were divided into the control group and the intervention group by random number table method,there were 78 cases in each group.The control group was given normal nursing 1 hour before surgery while the intervention group accepted visual preconditioning by covering the affected eye.Chinese Version of the Modified Yale Preoperative Anxiety Scale(Cm-YPAS)was used to evaluate the grade of anxiety for the patients during the process of anesthesia induction.Pediatric Anesthesia Emergence Delirium(PAED)was used to compare the score of emergence agitation and the incidence rate of emergence agitation of the two groups.Results Finally,75 cases were included in the intervention group and 75 cases in the control group.During anesthesia induction,the intervention group scored(39.78±4.84)and the control group scored(41.07±5.09)with Cm-YPAS,and there was no statistical difference between the two groups(P>0.05).Furthermore,compared the PAED score of the intervention group 5(4,8)with the control group 8(5,11),there were statistically significant differences between the two groups(Z=-3.07,P<0.01).Emergence agitation incidence in the intervention group was 14.67%(11/75),which was lower than that in the control group 38.67%(29/75),the difference was significant(χ^(2)=11.05,P<0.01).Conclusions Visual preconditioning can effectively improve recovery quality after general anesthesia and decrease the incidence rate of emergence agitation in ophthalmic surgery among preschool pediatric patients.It′s well worthy of application and dissemination of visual preconditioning clinically.