Effect of interesting games on relief of preoperative anxiety in preschool children

Purpose:To evaluate the effect of interesting games on reducing preoperative anxiety and improving compliance with anaesthesia in children.Methods:Ninety preschool-aged children undergoing elective surgery were randomly assigned to two groups.The children in the control group were admitted to a general preoperative room with one parent for 15e20 min,and were then taken into the anaesthesia room.During anaesthetic induction,the nurse attracted the children’s attention using an interesting game with encouragement and attention diversion.The children’s anxiety was assessed using the Modified Yale Preoperative Anxiety Scale(mYPAS)when they entered the operating room,while they were waiting to undergo s0urgery,and during anaesthetic induction.Moreover,the children’s compliance with anaesthetic induction was assessed using the Induction Compliance Checklist(ICC).Results:No statistically significant differences in the mYPAS scores were observed between the two groups upon entering the operating room(p>0.05).The mYPAS scores were significantly lower in the experimental group than in the control group while waiting for surgery and during anaesthetic induction(p<0.05),while there were no significant differences in the mYPAS scores upon entering the operating room.The children’s compliance with anaesthetic induction was significantly higher in the experimental group than in the control group(p<0.05).Conclusion:Engagement in an interesting game can reduce preschool-aged children’s preoperative anxiety and improve their compliance with anaesthetic induction.

The Effectiveness of Video Distraction on Children Preoperative Anxiety: An Integrative Literature Review

Background: Children who undergo a day case surgery experience high levels of preoperative anxiety. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long term postoperative complications. Recently, video distraction intervention has been evaluated for its anxiolytic effects in preoperative children. Aim: The aim of this integrative review was to demonstrate the varying methodological approaches utilized to evaluate the effectiveness of a video distraction intervention in reducing preoperative anxiety in children undergoing day case surgery. Methods: A total of 8 articles, meeting the inclusion criteria, were evaluated and included. Findings: The eight studies investigating the effect of video distraction on children preoperative anxiety concluded that video distraction was significant in controlling children preoperative anxiety. Four of the eight studies (50%), investigated video distraction effectiveness against pharmacological comparisons and demonstrated superior or equal anxiolytic effect of video distraction on different points along the surgical continuum. Three of the eight studies compared video distraction against parental presences and video distraction showed superior anxiolytic effect. Three of the eight studies evaluated the effect of video distraction on anesthesia induction compliance and emergence delirium. A significant effect on anesthesia induction was demonstrated while non-significant effect on emergence delirium was documented. Conclusion: Video distraction is a safe, time and cost effective non pharmacological anxiolytic intervention. It can be provided by nurses to control children high level of anxiety before surgery and during anesthesia induction.

The Association between Preoperative Parental Anxiety and Emergence Agitation in Preschoolers

Introduction: The preoperative distress and anxiety experienced by preschoolers are associated with an increased incidence of troubled recovery from anesthesia. However, influences of parental anxiety on children at different stages of the surgical processes are not clear. The aim of this study was to evaluate any existing association between preoperative parental anxiety and emergence agitation in a pediatric surgery population. Materials and Methods: A total of 60 children ASA class I or II, aged 3 - 12 years old, undergoing adenotonsillectomy with sevoflurane, were included in the study. Before surgery, we used State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety. Emergence agitation of the children was assessed with Watcha scale and recorded every 10 min of first 30 min of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate their satisfaction, post operative pain and any side effect observed in the children. Results: Preoperatively, the mean STAI-S scores of mothers were significantly higher than those of fathers (p 0.05). The children had the highest agitation scores at 10th postoperative minutes with an incidence of 73.9%. There was no correlation between parental anxiety and emergence agitation. Logistic regression analysis showed that low educational level of the parent was the only independent factor for state anxiety (OR: 8.96, 95% CI: 1.50 - 40.35, p = 0.030). Discussion: In this study, we observed that education level of the parents might affect their preoperative anxiety. The factors influential in parental anxiety were not correlated with pediatric emergence agitation in this study.

The Impact on the Level of Anxiety and Pain of the Training before Operation Given to Adult Patients

Aim: The aim oh this study was to detrmine the effects of different training programs implemented before inguinal hernia operation on the pre- and post-operation anxiety level of and pain level the patient. Material and method: This quasi experimental study was carried out with inguinal hernia patients 18 - 60 years who were hospitalized in the General Surgery Clinic of Hospital of Atatürk University and Süleyman Demirel Medical Centre in Erzurum for inguinal hernia operation. The study data were collected between November 2007-May 2008 from a total of 90 patients. 30 patients were in the control group, 30 were in the video (VCD) training group, and 30 were in the booklet training group. Data were collected by means of a questionnaire about the patients and the inventory of state anxiety fort he adult. In collecting data, patient introduction form and Spielberger’in State-Trait Anxiety Inventory, and visual analogue scale (VAS) were used. In data assessment, T-test, Pearson correlation test, Mauchly’s variance analysis, Anova for repeated measures tests and Bonferroni Correction Analysisi were used. Results: In control, booklet and VCD groups, In group Situational Constant Anxiety score average was found significant in each three time periods (p < 0.001). When the pain situations of the patients after operation was considered, the distinction in Visual Analogue Scale and Verbal Rating Scala values of two groups in all measurement times was found significant (p<0.001). Conclusion: In the conclusion of the study, it was found out that the given education effective on level of pain and anxiety score for experimental groups of patients.

Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery

BACKGROUND Preschoolers become anxious when they are about to undergo anesthesia and surgery,warranting the development of more appropriate and effective interventions.AIM To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery.METHODS One hundred and sixteen preschool-aged children were selected and assigned to the drug(n=37),intervention(n=40),and control(n=39)groups.All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation.The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments.The control group received no intervention.The modified Yale Preoperative Anxiety Scale was used to evaluate the children’s anxiety level on the day before surgery(T0),before leaving the preoperative preparation room(T1),when entering the operating room(T2),and at anesthesia induction(T3).Compliance during anesthesia induction(T3)was evaluated using the Induction Compliance Checklist(ICC).Changes in mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were also recorded at each time point.RESULTS The anxiety scores of the three groups increased variously at T1 and T2.At T3,both the drug and intervention groups had similar anxiety scores,both of which were lower than those in the control group.At T1 and T2,MAP,HR,and RR of the three groups increased.The drug and control groups had significantly higher MAP and RR than the intervention group at T2.At T3,the MAP,HR,and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group.Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction(T3),both of which were higher than those of the control group.CONCLUSION Combining static cartoons with dynamic virtual environments as effective as medication,specifically midazolam,in reducing preoperative anxiety and fear in preschool-aged children.This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.

Psychological intervention based on social cognitive theory: Treating pain, anxiety, and depression in perioperative patients

BACKGROUND Surgery is an effective method for treating certain diseases.Factors such as disease,preoperative fear and tension,surgical stress,postoperative pain,and related complications directly affect the smooth progression and outcome of surgery.Patients may experience a series of psychological and physiological changes during the perioperative period,resulting in anxiety and depression,which may reduce the pain threshold and worsen their prognosis.METHODS We enrolled 200 patients who underwent surgical care at The First People’s Hospital of Lin’an District,Hangzhou between January and December 2023.They were categorized into a routine intervention group(n=103)and a psychological intervention group(n=97),based on the intervention strategies used.Various assessment tools,including the self-rating anxiety scale(SAS),the self-rating depression scale(SDS),and the Connor–Davidson Resilience scale,were used to measure patients’negative states and emotions.The pre-and post-intervention scores for these metrics in the two groups were then analyzed.RESULTS In the psychological intervention group,the SAS and SDS scores(31.56±5.18 and 31.46±4.57,respectively)were significantly reduced compared to the routine intervention group(P<0.05).The visual analog scale pain scores at 12 and 24 hours after intervention(6.85±1.21,4.24±0.72)were notably higher than those in the routine intervention group(P<0.05).The psychological intervention group also demonstrated superior scores in perseverance(36.08±3.29),self-reliance(22.63±2.91),optimism(11.42±1.98),and resilience(70.13±5.37),compared to the routine intervention group(P<0.05).Additionally,the psychological intervention group’s confrontation score(23.16±4.29)was higher(P<0.05).This group also reported lower scores in avoidance(9.28±1.94)and yielding(6.19±1.92)(P<0.05).Lastly,the Short Form 36 Health Survey scores were significantly higher in the psychological intervention group,indicating a better quality of life(P<0.05).CONCLUSION Psychological intervention measures based on SCT can effectively alleviate pain,anxiety,and depression in periop-erative patients.

Can acupuncture therapy reduce preoperative anxiety?A systematic review and meta-analysis

Background:Acupuncture therapy has shown promise for effectively relieving preoperative anxiety.Nevertheless,previous findings from randomized controlled trials(RCTs)are inconsistent and must be examined in detail.Objective:This study systematically evaluates the efficacy and safety of acupuncture therapy for preoperative anxiety as well as the quality of evidence supporting this application.Search strategy:The China National Knowledge Infrastructure Database,Wanfang Data Journal Database,Chinese Biomedical Literature Database,Chongqing VIP,Embase,Pub Med and Cochrane Library Databases were queried from their inception to 19,February 2020,using keywords such as“acupuncture therapy,”“preoperative”and“anxioty.”Manual searches expanded the search breadth and included conference abstracts and other reference lists.Inclusion criteria:RCTs were included in the current study if they contained a comparison between a group of anxiety patients that received acupuncture therapy and a control group that received sham acupuncture.Data extraction and analysis:Literature was reviewed,and various articles were selected using the Note Express 3.2.0 software.Two researchers independently screened and extracted data and evaluated the risk of bias in the included studies.The Rev Man 5.3 software was used for data aggregation and the Grades of Recommendation,Assessment,Development and Evaluation(GRADE)assessment was used to evaluate the quality of the study outcomes.Results:Twelve studies were included in the review,containing a total of 916 patients.Meta-analysis showed that,compared with the control group,patients who received acupuncture therapy had reduced State-Trait Anxiety Inventory Scale(STAI-S)score(mean difference[MD]=–9.07,95%confidence interval[CI][–13.19 to–4.96],P<0.0001)and Visual Analogue Scale(VAS)score(MD=–1.37,95%CI[–2.29 to–0.45],P=0.003).However,for the Hamilton Anxiety Scale(HAMA)score,there was no difference between the two groups(MD=–3.98,95%CI[–12.89 to 4.92],P=0.38).Further,the GRADE assessment demonstrated that the STAI-S was of moderate quality,the VAS of low quality and the HAMA of very low quality.Conclusion:Acupuncture therapy may be able to decrease anxiety in preoperative patients,but the results need to be further verified due to the small sample sizes and the low quality of evidence to date.

Risk Factors for Preoperative Anxiety and Depression in Patients Scheduled for Abdominal Aortic Aneurysm Repair

Background： Perioperative emotional disorders of patients underwent abdominal aortic aneurysm （AAA） repair is an emerging area of study, and preoperative mental distress of those patients remains poorly understood. The aim of this study was to investigate the prevalence and identify the risk factors of preoperative anxiety and depression in patients scheduled for AAA repair. Methods： A total of 189 patients who underwent elective AAA repair between 2015 and 2016 were included in this study. These patients were preoperatively evaluated by Hospital Anxiety and Depression Scale （HADS）. Demographics and anxiety and depression scores of the patients were documented. Logistic regression was used to identify the independent risk factors of preoperative anxiety and depression. Results： A total of 150 AAA patients were included in final analysis. Of these 150 patients, 44 patients （29.3%） had borderline anxiety or clinical anxiety, and 42 patients （28.0%） were found to have borderline or clinical depression. Female （odds ratio [OR]： 2.81, 95% confidence interval [C1]： 1.08-7.26）, the American Society of Anesthesiologists （ASA） Grade 3/4 （OR： 4.34, 95% CI： 1. 13-16.68）, higher education （OR： 1.44, 95% CI： 1.02-2.04）, and abdominal or back pain （OR： 3.08, 95% CI： 1.20-7.87） were identified as significant independent risk factors of abnormal HA DS-anxiety in overall patients; and higher level of education （OR： 1.87, 95% CI： 1.16-3.01） was predictive of anxiety in patients planned for endovascular aortic repair. Besides, higher body mass index （BMI） （OR： 1.18, 95% CI： 1.04-1.33） and abdominal or back pain （OR： 3.93, 95% CI： 1.70-9.11） were predictive of abnormal preoperative HADS-depression in overall patients. Conclusion： As for patients scheduled for AAA repair, female, higher ASA, higher level of education, and symptom may be independent risk factors for preoperative anxiety, and symptom and higher BMI may predict preoperative depression.

Clinical Significance of Preoperative Nutritional Risk Screening and Support in the Perioperative Period of Gastric Cancer Patients

Objective:To investigate the clinical value of using preoperative nutritional risk screening and support in gastric cancer patients.Methods:In this paper,70 gastric cancer patients selected from July 2017 to July 2020 treated in our hospital were grouped concerning the lottery method,and the reference group(n=35)used conventional nutritional support,while the experimental group(n=35)used preoperative dietary risk screening and support,comparing the clinical treatment differences between gastric cancer patients in the experimental group and the reference group.Results:After the intervention,IgA,IgM,IgG,serum albumin,complication rate,NRS score,hospitalization time and anal exhaust time of gastric cancer patients in the experimental group were compared with those in the reference group,P<0.05,and there was statistical validation analysis significance between the data indicators.P<0.05 for the comparison of IgA,IgM,IgG,serum albumin after the intervention and pre-intervention for gastric cancer patients in the experimental group and the reference group,with statistical validation analysis significance between the data indicators.Conclusion:Preoperative nutritional risk screening and support is of significant value in gastric cancer patients and can improve patients’nutritional status.

快速康复理念下家庭参与式护理模式在 肺结节围术期患者护理中的应用

目的观察肺结节围术期护理中实施快速康复理念下家庭参与式护理模式的效果。方法选取行手术治疗的肺结节患者180例,采取随机数字表法分为对照组和观察组,每组90例。对照组患者应用常规护理,观察组实施快速康复理念下家庭参与式护理模式。比较2组患者术后时间结局指标、术前焦虑情况、家庭负担及术后训练积极性。结果观察组患者胸管留置时间及住院总时间均短于对照组,差异有统计学意义(P<0.05);干预后,观察组患者阿姆斯特丹术前焦虑与信息量表(APAIS)及疾病家庭负担量表(FBS)得分低于对照组,差异有统计学意义(P<0.05);观察组患者术后训练积极度水平高于对照组,差异有统计学意义(P<0.05)。结论实施快速康复理念下家庭参与式护理模式有利于促进肺结节手术患者早期康复,缓解患者术前焦虑情况,减轻家庭负担,提高患者术后康复训练积极性。

基于虚拟现实技术的正念训练对化疗期卵巢癌患者负性情绪及疲乏的影响

目的 :研究基于虚拟现实技术与正念相融合的训练方式对化疗期卵巢癌患者负性情绪及疲乏程度的影响,以期提升化疗期卵巢癌患者负性情绪管理水平,降低其疲乏程度。方法 :通过虚拟现实技术,设计并开发了正念训练的软件。便利选取2022年8月至2023年1月在北京市某三级医院妇科住院治疗的25例化疗期卵巢癌患者作为研究对象,实施为期1周的基于虚拟现实技术的正念训练,对患者进行基于虚拟现实技术的正念训练使用接受度评价,比较干预前后患者焦虑、抑郁、疲乏情况。结果 :基于虚拟现实技术的正念训练方式包含个性化课程、智能监测、情绪追踪、趣味游戏4个功能模块。25例患者使用接受度评分为(164.68±9.28)分,属于高度适应性。使用基于虚拟现实技术的正念训练后,化疗期卵巢癌患者焦虑、抑郁得分及癌因性疲乏总分降低了(P<0.05)。结论 :化疗期卵巢癌患者对基于虚拟现实技术的正念训练接受度较高,应用该方式可改善化疗期卵巢癌患者的负性情绪及疲乏程度,值得推广使用。

咪达唑仑对术前中重度焦虑老年患者结直肠癌根治术后谵妄的影响

目的探讨术前短期口服咪达唑仑对术前合并中重度焦虑老年患者结直肠癌根治术后谵妄的影响。方法选择择期行腹腔镜结直肠癌根治术的老年患者80例,男32例,女48例,年龄65~79岁,BMI 21~27 kg/m^(2),ASAⅡ或Ⅲ级,入院时状态特质焦虑量表(STAI-S)评分≥38分。采用随机数字表法将患者分为两组:对照组和咪达唑仑组,每组40例。咪达唑仑组予咪达唑仑7.5 mg每晚一次,连续服药3~4 d,直到术前1 d;对照组予外观相似的安慰剂半片。记录术前1 d STAI-S评分与术后3 d内谵妄的发生情况,记录入室时、麻醉诱导后30 min、1、2 h、拔管后30 min HR和MAP,记录术中丙泊酚、瑞芬太尼、右美托咪定用量及间羟胺使用情况,记录拔管后30 min、术后24、72 h视觉模拟评分(VAS)、曲马多使用情况以及拔管时间。结果与对照组比较,咪达唑仑组术前1 d STAI-S评分、术后谵妄发生率、术中间羟胺使用率、拔管后30 min、术后24 h VAS疼痛评分、曲马多使用率明显降低(P<0.05)。两组术中丙泊酚、瑞芬太尼、右美托咪定用量和拔管时间差异无统计学意义。结论术前口服咪达唑仑可有效降低合并术前中重度焦虑老年患者结直肠癌根治术后谵妄的发生。

互联网+“手术e候厅”对腹腔镜全子宫切除术患者术前访视知晓度及焦虑水平的影响

目的:探讨互联网+“手术e候厅”对全子宫切除术患者术前访视知晓度及焦虑水平的影响。方法:选取2022年1月-2023年10月本院行腹腔镜全子宫切除术患者102例,随机数字表法分为对照组和观察组各51例,分别予以常规围术期护理模式干预或互联网+“手术e候厅”护理模式干预。比较两组术前访视知晓度、不同时间点焦虑程度(包括家属)、心理及血压变化情况、护理满意度。结果:观察组术前访视知晓度及护理满意度(92.2%)均优于对照组(76.5%),手术室等候时的心率(76.48±9.23)、血压(114.39±6.54 mmHg/76.07±7.13 mmHg)均低于对照组(83.51±8.19、123.58±8.42 mmHg/84.54±6.49 mmHg),手术室等候时、术后1 d 7项广泛性焦虑障碍量表(GAD-7)评分(7.19±2.58分、3.15±1.02分)均低于对照组(9.35±3.26分、4.21±1.07分),其家属手术等候时GAD-7评分(6.28±2.26分)也低于对照组(8.39±2.11分)(均P<0.05)。结论:应用互联网+“手术e候厅”干预可提高全子宫切除术患者术前访视知晓度,缓解焦虑情绪,利于保持心率、血压平稳,护理满意度提高。

喉癌患者围手术期快速康复查检单的设计与应用

目的 设计喉癌患者围手术期快速康复查检单并探讨其应用效果,以便更好地指引和规范护士在喉癌患者围手术期快速康复的行为。方法 采用前-后对照研究法,将本科室2020年4月至9月收治的35例喉癌患者设为对照组,2020年10月至2021年4月收治的37例喉癌患者设为试验组。对照组采用常规喉癌围手术期快速康复方案,试验组在对照组基础上成立喉癌快速康复持续治疗改进小组,通过文献回顾、专家咨询等方法设计喉癌患者围手术期快速康复查检单并在临床应用。比较两组患者喉癌围手术期快速康复措施的执行规范率,医护人员对快速康复方案执行的满意度,患者平均住院日和满意度。结果 试验组患者围手术期快速康复措施规范执行率为93.28%,患者满意度为(95.57±2.25)分,医生对快速康复方案执行满意度为(35.75±0.89)分,护士对快速康复方案执行满意度为(35.45±1.10)分,高于对照组84.08%、(92.60±2.49)分、(32.88±1.50)分、(33.00±1.30)分;试验组患者平均住院日为(9.89±3.32)d,低于对照组(12.60±4.33)d,两组比较,差异具有统计学意义(均P<0.05)。结论 喉癌患者围手术期快速康复查检单可提高患者快速康复措施的执行规范率,并提高医护人员及患者满意度,促进患者康复。

口服不同剂量咪达唑仑对腹腔镜腹股沟斜疝疝囊高位结扎术患儿术前焦虑的影响

目的观察口服不同剂量咪达唑仑用于缓解腹腔镜腹股沟斜疝疝囊高位结扎术患儿术前焦虑的效果。方法选择择期在全麻下行腹腔镜腹股沟斜疝疝囊高位结扎术的患儿120例,男93例,女27例,年龄2~6岁,身高78~120 cm,体重11~25 kg,ASAⅠ或Ⅱ级。采用随机数字表法将患儿分为三组:麻醉前30 min口服咪达唑仑0.25 mg/kg组(M1组)、0.5 mg/kg(M2组)和0.75 mg/kg(M3组),每组40例。记录服药前、与父母分离时、麻醉诱导即刻简化版改良耶鲁术前焦虑量表(mYPAS-SF)评分和麻醉诱导期合作度量表(ICC)评分。记录苏醒时间、拔管时间、PACU停留时间、术后30 min儿童麻醉苏醒期躁动量表(PAED)评分和改良面部表情疼痛量表(FLACC)评分。结果与服药前比较,M2组和M3组在与父母分离时、麻醉诱导即刻mYPAS-SF评分明显降低(P<0.05)。与M1组比较,M2组和M3组与父母分离时、麻醉诱导即刻mYPAS-SF明显降低(P<0.05),麻醉诱导即刻ICC评分明显降低(P<0.05),苏醒时间、拔管时间和PACU停留时间明显延长(P<0.05),术后30 min PAED评分明显降低(P<0.05)。与M2组比较,M3组苏醒时间和拔管时间明显延长(P<0.05)。结论麻醉前30 min口服咪达唑仑0.5 mg/kg或0.75 mg/kg均可有效缓解患儿术前焦虑,提高麻醉诱导合作度,降低术后躁动的发生,口服咪达唑仑0.75 mg/kg的患儿苏醒时间和拔管时间延长,因此,口服咪达唑仑0.5 mg/kg为患儿术前抗焦虑方案比较合适的剂量。

飞秒激光小切口角膜微透镜取出术病人围术期焦虑变化趋势及其影响因素

目的:探讨飞秒激光小切口角膜微透镜取出术(SMILE)病人围术期不同时间点心理体验的动态变化及影响因素。方法:选择郑州市某三级甲等医院视光中心就诊的SMILE 226例病人,采用一般资料和临床特征调查表、心理弹性量表、医学应对方式问卷、特质焦虑量表和状态焦虑量表在术前检查(T0)、手术当天(T1)、术后1 d(T2)、术后1周(T3)、术后1个月(T4)5个时间点纵向评估SMILE病人围术期焦虑状况,采用重复测量方差分析探讨焦虑的时间效应,相关性分析探讨每个时间点的相关因素,并采用广义估计方程探讨影响因素。结果:最终纳入病人208例。SMILE病人围术期5个时间点状态焦虑量表得分分别为(34.25±8.77)分、(38.22±9.25)分、(36.89±11.28)分、(34.04±11.02)分和(30.50±9.91)分。相关性分析结果显示,病人近视程度、与家人关系、屈服应对方式、心理弹性、焦虑特质在5个时间点皆与焦虑具有相关性,性别在T0、T1、T2、T4时间点与焦虑相关,而居住地只在T4时与焦虑相关。广义估计方程结果显示,性别、月收入、年龄、文化程度、居住地、既往手术史、心理弹性、屈服应对方式和焦虑特质为SMILE病人围术期焦虑的影响因素。结论:SMILE病人围术期焦虑呈先上升后下降趋势,影响因素在不同时间点表现不同,护士可针对不同时间点影响因素制订个性化护理措施,降低病人焦虑状况。

成人择期手术术前焦虑非药物管理审查指标的制订及障碍与促进因素分析

目的:开展成人择期手术术前焦虑非药物管理的临床审查,构建基于证据的审查指标,系统分析障碍因素及促进因素,制定行动策略。方法:以渥太华研究应用模式为指导组建团队,确定临床问题,系统检索、评价及整合证据,构建审查指标及明确审查方法,开展临床实践行为的现状审查,并根据审查结果,从基于证据的变革、潜在采纳者和实践环境3个方面分析证据应用的障碍及促进因素,制定相应的行动策略。结果:最终纳入27条最佳证据,共制订16条审查指标进行质量审查,其中12条指标依从率<60%,其中9条指标依从率为0。对审查结果逐条分析,得出障碍因素:在证据变革方面,包括证据内容不具体、不可及;在潜在采纳者方面,包括增加护士工作量、护士缺乏相关知识和技能;在实践环境方面,包括缺乏多学科沟通机制、缺乏证据转化所需各项物质资料(如特异性的评估工具及流程、以病人需求为导向的术前教育材料等);主要的促进因素为:医院具备良好的循证氛围、获得领导支持、具备项目开展所需的相关技术人员等。结论:成人择期手术术前焦虑非药物管理的最佳证据与临床实践存在较大差距,可通过系统地深度剖析证据临床应用的障碍因素,制定针对性策略,以促进证据融入临床。

围绝经期及绝经后女性中医证型与焦虑、抑郁情绪的相关性

目的探讨围绝经期及绝经后女性中医证型与焦虑、抑郁情绪的相关性。方法借助自主研发的更年期应用程序收集围绝经期及绝经后女性的资料,同时采用广泛焦虑障碍量表(GAD-7)、抑郁筛查量表(PHQ-9)进行焦虑、抑郁情绪评估,分析围绝经期及绝经后女性焦虑、抑郁情绪发生情况以及中医证型与焦虑、抑郁情绪的相关性。结果①共收集有效病例2379例,其中伴有焦虑情绪者737例、伴有抑郁情绪者826例,同时伴有焦虑、抑郁情绪者537例。月经情况、流产史、生育史对焦虑情绪的发生有影响(P<0.05),而年龄、月经情况、流产史、生育史对抑郁情绪的发生有影响(P<0.05)。②不同程度(轻度、中度、中重度/重度)焦虑、抑郁情绪的人数分布比较,差异无统计学意义(P>0.05)。③不同中医证型在焦虑、抑郁情绪中的分布,差异具有统计学意义(P<0.05)。④肾虚肝郁证与轻度、中度、重度焦虑情绪有较强关联性,尤其与轻度焦虑情绪关联性最强;肾阴阳两虚证、肝肾阴虚证、心肾不交证与无焦虑情绪关联性较强。肾虚肝郁证与轻度、中度、中重度/重度抑郁情绪有较强关联性,尤其与轻度、中度抑郁情绪关联性最强;肝肾阴虚证、心肾不交证、肾阴阳两虚证与无抑郁情绪有较强关联性。结论围绝经期及绝经后女性焦虑、抑郁情绪的发生与肾虚肝郁证的关联性最强,因此在临床工作中更应关注肾虚肝郁证围绝经期及绝经后女性的情绪状态,在早期采用补肾疏肝法进行治疗,改善患者的症状,提高围绝经期及绝经后女性的生活质量。

放松训练联合呼吸操对急性下肢深静脉血栓患者术前焦虑术后疼痛及治疗配合度的影响

目的 探讨放松训练联合呼吸操对血栓清除术治疗急性下肢深静脉血栓(LEDVT)患者术前焦虑、术后疼痛及治疗配合度的影响。方法 将96例急性LEDVT患者根据随机数字表法分为对照组和观察组,各48例。对照组患者给予常规干预,观察组患者给予放松训练联合呼吸操干预。采用汉密顿焦虑量表(HAMA)、广泛性焦虑量表(GAD-7)、视觉模拟评分法(VAS)、自制治疗配合度调查问卷及纽卡斯尔护理满意度量表(NSNS)评估两组患者术前焦虑情况、术后疼痛、治疗配合度及护理满意度,统计并比较两组患者住院期间并发症发生率。结果 干预后,两组患者HAMA、GAD-7评分均较干预前降低,且观察组患者HAMA、GAD-7、VAS评分均低于对照组(P<0.01);观察组患者治疗配合度、护理总满意度均高于对照组(P<0.05)。观察组患者并发症总发生率低于对照组,但差异无统计学意义(P>0.05)。结论 放松训练联合呼吸操可有效改善LEDVT患者行血栓清除术前的焦虑状态,缓解患者术后疼痛情况,显著提高患者治疗配合度及护理满意度,具有临床推广价值。

心率变异性分析对老年患者术前鼻喷小剂量右美托咪啶的临床评价

目的:探讨心率变异(HRV)分析评价小剂量经鼻喷雾右美托咪定对颌面外科老年患者术前焦虑和气管插管应激反应的影响。方法:按照随机数字表法将口腔颌面外科择期手术的患者60例分为2组(n=30)。右美托咪定组(D组)术前经鼻喷雾右美托咪定0.5μg/kg;对照组(C组)等量生理盐水,均采用静吸复合麻醉。比较两组患者术前(T0)、入室(T1)及气管插管(T2)时的血流动力学、心率变异性指标、镇静评分及BIS值变化。结果:T1时,D组与C组Ramsay评分分别为2.8±0.7和1.1±0.3,BIS值分别为87.3±6.1和97.4±0.5,SD1分别为20.9±7.0和15.4±5.4,SDNN分别为30.9±6.6和37.1±7.0,LF/HF分别为1.3±0.3和2.6±0.4(P<0.01)。T2时,D组与C组SD1分别为10.4±3.5和7.7±3.1,SDNN分别为59.2±6.5和70.1±7.1,LF/HF分别为5.1±0.5和7.5±0.5(P<0.01)。结论:右美托咪定小剂量鼻腔喷雾能够有效缓解颌面外科老年患者术前焦虑并且可以减小气管插管应激反应。