舒适化护理对日间手术儿童术前焦虑和术后早期转归的影响

Effects of comfort nursing on preoperative anxiety and postoperative early outcomes in children undergoing day surgery

目的探讨舒适化护理对日间手术儿童术前焦虑和术后早期转归的影响。方法选取2020年1—12月于首都儿科研究所附属儿童医院接受日间手术治疗的1~14岁儿童共451例,根据随机数字表法分为对照组(227例)和观察组(224例)。对照组采取常规护理,观察组采取舒适化护理。采用改良耶鲁术前焦虑评分(mYPAS)评价患儿的术前焦虑水平;对儿童麻醉苏醒期躁动进行评分并计算苏醒期躁动(>12分)发生率;术后3 d通过电话随访,采用住院后行为问卷调查患儿不良行为发生率,以及调查家长对医疗护理服务的满意度评分分级。结果观察组与对照组相比,mYPAS[5.0(5.0,7.0)分vs.10.0(8.0,15.0)分]、苏醒期躁动[23例(10.3%)vs.101例(44.5%)]和术后不良行为改变[5例(2.2%)vs.40例(17.6%)]均显著降低(均P<0.05),家长满意度分级更优(P<0.05)。结论舒适化护理可有效缓解日间手术患儿术前焦虑,降低麻醉苏醒期躁动和术后不良行为改变的发生率,适于在儿童日间手术中心普及推广。

Objective To explore the effects of comfort nursing on preoperative anxiety and postoperative early outcomes in children having day surgery.Methods A total of 451 children aged 1-14 years old and undergoing day surgery at Children’s Hospital Affiliated to Capital Institute of Pediatrics from January 2020 to December 2020 were enrolled,and they were randomly divided into the control(n=227)and observation(n=224)groups based on the random number table method.The control group was subjected to standard nursing.The observation group received comfort nursing.The preoperative anxiety level of children was assessed with modified Yale preoperative anxiety scale(mYPAS).The post-anaesthesia emergence agitation score was determined,and the rate of post-anesthesia emergence delirium(those with a score>12 points)was calculated.Three days after surgery,a telephone follow-up was conducted to investigate the incidence of negative behaviour change in the children with post-hospitalisation behaviour questionnaire and to investigate the satisfaction grade of parents with medical care services.Results Compared with the control group,the mYPAS score[5.0(5.0,7.0)points versus 10.0(8.0,15.0)points],incidence of agitation during recovery[23(10.3%)versus 101(44.5%)]and incidence of postoperative adverse behaviour change[5(2.2%)versus 40(17.6%)]significantly decreased(all P<0.05)in the observation group,and the satisfaction grade of parents was better(P<0.05).Conclusion Comfort nursing is effective in relieving preoperative anxiety and reducing the incidence of anaesthesia emergence agitation and negative postoperative behaviour changes in children undergoing day surgery,and should be popularised in children’s day surgery centres.