预防全身麻醉手术患儿术前焦虑的非药物管理策略证据总结

Evidence summary of non-pharmacological management strategies for preventing preoperative anxiety in children undergoing general anesthesia surgery

目的:检索、评价和总结预防全身麻醉手术患儿术前焦虑的最佳证据,为建立基于最佳证据的全身麻醉患儿术前焦虑非药物管理策略提供参考。方法:根据“6S”证据模型,计算机检索各指南网、指南库、UpToDate、Joanna Briggs Institute(JBI)循证卫生保健中心数据库、EMbase、BMJ-Best Practice、国际指南图书馆、CINAHL、PubMed、the Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普数据库(VIP)、万方数据库等关于预防全身麻醉手术患儿术前焦虑非药物性干预策略的所有证据,包括指南、专家共识、证据总结、最佳临床实践手册、系统评价/Meta分析、随机对照研究(RCT)。检索时限为建库至2022年6月1日。结果:共纳入16篇文献,其中1篇临床决策,1篇指南,12篇系统评价/Meta分析,2篇RCT,总结出患儿术前焦虑高危因素的评估、术前非药物管理措施、手术转运、麻醉诱导前的非药物管理策略4个方面,共12条证据。结论:现有证据表明,患儿术前焦虑的高危因素有性格类型、父母焦虑水平,而年龄、性别等与患儿术前焦虑的关系尚不明确。采用与患儿年龄相适应的术前评估、多手段相结合的术前宣教、转运、麻醉诱导前干预能有效缓解全身麻醉患儿术前焦虑水平。

Objective:To retrieve,evaluate and summarize the best evidence for preventing preoperative anxiety in children undergoing general anesthesia surgery,so as to provide a reference for establishing a non-drug management strategy for preoperative anxiety in children undergoing general anesthesia based on the best evidence.Methods:According to"6S"evidence model,the major guideline networks,guideline database,UpToDate,JBI Evidence-based Health Center database,EMbase,BMJ-Best Practice,International Guideline Library,CINAHL,PubMed,the Cochrane Library,CBM,CNKI,VIP,WanFang database were retrieved.All evidence on non-pharmacological intervention strategies to prevent preoperative anxiety in children undergoing surgery under general anesthesia.These included guidelines,expert consensus,evidence summary,best clinical practice manual,systematic review/Meta-analysis,RCT.The retrieval time was from the inception to June 1,2022.Results:A total of 16 articles were included,including 1 clinical decision,1 guideline,12 systematic reviews/Meta-analysis,and 2 RCTS.12 best evidences were summarized from 4 aspects:assessment of high risk factors of preoperative anxiety in children,preoperative non-drug management measures,surgical transports,and non-drug management strategies before induction of anesthesia.Conclusion:Current evidence shows that the high risk factors of preoperative anxiety in children include temperament type and parental anxiety level,while the relationship between age and gender related to preoperative anxiety in children is still unclear.Preoperative evaluation appropriate to the age of children,preoperative education,transport and pre-anesthesia induction intervention combined with multiple means can effectively relieve the preoperative anxiety level of children under general anesthesia.