多元化兴趣诱导护理干预对学龄前包皮环切术患儿应激水平的影响

Influence of nursing intervention induced by diversified interest on stress level in preschool circumcised children

目的探讨多元化兴趣诱导护理干预对学龄前包皮环切术患儿应激水平的影响。方法选择2021年3月—2022年7月在浙江省瑞安市人民医院手术室实施包皮环切术的156例患儿作为研究对象。采用随机数字表法,将其分别设为试验组(80例)和对照组(76例)。试验组患儿实施多元化兴趣诱导护理干预,对照组患儿实施常规护理。采用中文版改良耶鲁术前焦虑量表(m-YPAS)在术前1天(T_(0))、进入手术等候室5 min(T_(1))、进入手术室5 min(T_(2))、麻醉诱导时(T_(3))进行患儿焦虑状态评估。麻醉诱导后记录患儿收缩压、舒张压、心率和血氧饱和度,并抽取其静脉血检测肾上腺素和皮质醇。术后1个月通过创伤后应激障碍(post-traumatic stress disorder,PTSD)半结构式访谈进行患儿创伤后应激障碍评估。结果两组患儿T_(0)时刻的m-YPAS评分差异无统计学意义(P>0.05);试验组患儿T_(1)、T_(2)和T_(3)时刻的m-YPAS评分[(34.1±14.8)分、(38.5±15.7)分、(49.3±18.9)分]均显著低于对照组患儿[(41.4±16.3)分、(51.6±18.4)分、(60.7±22.4)分],其差异均具有统计学意义(均P<0.05)。试验组患儿的肾上腺素和皮质醇水平、收缩压、舒张压和心率[(45.3±19.2)ng/mL、(169.7±43.8)pg/mL、(98.5±8.6)mmHg、(67.5±6.4)mmHg、(95.5±7.8)次/min]均低于对照组患儿[(58.6±22.1)ng/mL、(192.4±50.5)pg/mL、(106.6±9.8)mmHg、(72.1±7.5)mmHg、(104.2±10.3)次/min],其差异均具有统计学意义(均P<0.05)。试验组患儿术后PTSD症状阳性率(10例,12.5%)显著低于对照组患儿(20例,26.3%),其差异具有统计学意义(χ^(2)=4.789,P=0.029)。结论多元化兴趣诱导护理干预能够降低学龄前包皮环切术患儿的应激水平,减少PTSD症状,值得在护理工作中推广应用。

Objective To explore influence of nursing intervention induced by diversified interest on stress level in preschool circumcised children.Methods A total of 156 circumcised children from Operating Room,Rui'an People's Hospital in Zhejiang Province who were eligible from March 2021 to July 2022 were selected as the research subjects.The patients were divided into the experimental group of 80 cases and the control group of 76 cases by random number table.The experimental group was given nursing intervention induced by diversified interest,and the control group was given routine nursing care.Chinese version of the modified Yale preoperative anxiety scale(m-YPAS)was used to assess anxiety status on the day before surgery(T_(0)),5 minutes in the waiting room(T_(1)),5 minutes in the operating room(T_(2)),and at the time of anesthesia induction(T_(3)).Venous blood was drawn for epinephrine and cortisol after induction of anesthesia.Systolic blood pressure,diastolic blood pressure,heart rate,and oxygen saturation were recorded.Post-traumatic stress disorder(PTSD)assessment was performed 1 month after surgery through a semi-structured interview for PTSD.Results There was no significant difference in the m-YPAS score at T_(0) between the two groups(P>0.05),and the m-YPAS scores at T_(1),T_(2) and T_(3) in the experimental group(34.1±14.8,38.5±15.7,49.3±18.9)were all lower than those in the control group(41.4±16.3,51.6±18.4,60.7±22.4),and the differences were all statistically significant(all P<0.05).The epinephrine,cortisol,systolic blood pressure,diastolic blood pressure and heart rate of children in the experimental group[(45.3±19.2)ng/mL,(169.7±43.8)pg/mL,(98.5±8.6)mmHg,(67.5±6.4)mmHg,(95.5±7.8)/min]were all lower than those in the control group[(58.6±22.1)ng/mL,(192.4±50.5)pg/mL,(106.6±9.8)mmHg,(72.1±7.5)mmHg,(104.2±10.3)/min],and the differences were all statistically significant(all P<0.05).There were 10 cases(12.5%)in the experimental group with positive stress symptoms,and 20 cases(26.3%)in the control group with positive stress symptoms.The positive rate of stress symptoms in the experimental group was significantly lower than that in the control group(χ^(2)=4.789,P=0.029).Conclusions Nursing intervention induced by diversified interest can reduce the stress level of circumcised preschool children and reduce PTSD symptoms,which is worthy of promotion and application in nursing work.