父母干预对患儿术前焦虑影响的研究进展

随着我国经济的发展和科技的进步,患儿围术期舒适化医疗也在逐步推进中。舒适化医疗不仅减轻了患儿身体的病痛,更避免了手术和麻醉等操作对其心理造成的永久性创伤。患儿术前焦虑发生率高于成年患者,可对患儿围术期及预后产生不良影响。不同患儿父母的特征,如父母焦虑水平、父母受教育程度、父母社会经济背景、家庭组成及种族和语言等因素会影响患儿的术前焦虑水平。父母参与指导患儿麻醉前准备、管理患儿禁食禁饮和陪伴患儿接受麻醉诱导等干预措施可缓解患儿的术前焦虑水平。对于残疾患儿,父母在围术期与医务人员的信息沟通和对患儿的干预管理更为重要。与传统的术前准备方案比较,基于互联网的家庭术前准备平台可以为患儿家庭提供更加全面、有效、个性化的信息指导,保障患儿围术期舒适化医疗。     

肺高压患者非心脏手术的围术期麻醉进展

背景 肺高压(pulmonary hypertension,PH)患者行非心脏手术期间并发症发病率和病死率显著增高,围术期的麻醉处理是麻醉医师面临的挑战之一. 目的 综述近年PH及相关麻醉管理的研究文献,为麻醉医师的临床工作提供理论参考. 内容 阐述PH的定义及诊断,围术期并发症和死亡的预测因素,术前准备与评估,麻醉方式、麻醉管理以及严重并发症的处理. 趋向 随着对PH研究的深入,非心脏手术围术期麻醉管理会得到进一步优化,从而减少并发症和死亡的发生率.     

围手术期肺顺应性影响因素探讨

背景 良好的肺顺应性是维持围手术期呼吸功能的必要条件.随着科研和临床上对肺顺应性研究的逐步深入,围手术期患者肺顺应性的影响因素也越来越受到人们的重视. 目的 对围手术期肺顺应性影响因素的相关文献资料进行分析总结. 内容 主要从麻醉方式、麻醉药物、呼吸机设置、术中体位、特殊手术类型和患者自身因素等进行综述. 趋向 围手术期肺顺应性影响因素的探讨与研究,对患者的术前评估、术中肺保护和术后减少呼吸系统损伤都具有重要意义.     

基于儿童认知特点的骨折患儿围手术期焦虑管理的实践效果

目的 探讨基于不同阶段儿童认知特点制定的骨折患儿围手术期焦虑管理方案在临床中的应用效果。方法 选取2020年6月至2021年5月我院骨科收治的需手术治疗的四肢骨折患儿160例。将2020年6月至11月收治的80例骨折患儿纳入对照组,围手术期实施常规管理方案;2020年12月至2021年5月收治的80例骨折患儿纳入观察组,围手术期实施基于儿童认知特点的焦虑管理方案。采用改良耶鲁术前焦虑量表（m-YPAS）测评患儿入院时、术前30 min的焦虑评分;特质焦虑量表（T-AI）和状态焦虑量表（S-AI）分别测评患儿家属入院时和手术等待期的焦虑评分;满意度调查问卷调查患儿家长对护理的满意度。观察两组患儿焦虑评分、家属焦虑评分以及对护理工作的满意情况。结果 术前30 min,观察组患儿焦虑评分为（45.84±6.75）分,显著低于对照组的（57.91±6.96）分,差异有统计学意义（P＜0.001）;观察组患儿家属手术等待期的S-AI评分为（37.35±4.51）分,显著低于对照组的（46.25±5.74）分,差异有统计学意义（P＜0.05）。观察组家长对护理的满意度显著高于对照组为（95% vs. 75%）,差异有统计学意义（χ²=12.549,P＜0.001)。结论 基于儿童认知特点的骨折患儿围手术期焦虑管理方案有利于改善患儿和家属焦虑,提高患儿家长对护理工作的满意度,促进患儿舒适。     

多元化兴趣诱导宣教对学龄前患儿术前焦虑状态影响的研究进展

学龄前患儿身心发育尚不成熟、认知能力较差,处于认知发展水平的前运思期,他们面对陌生的手术室环境、与父母分离等情况极易产生焦虑,影响手术顺利进行。文章对近年来学龄前患儿术前实施兴趣诱导的理论基础、干预方法等内容进行梳理,为指导医护人员降低患儿术前恐惧,减轻术前焦虑,保障围手术期安全提供更有效的干预方案,以期为患儿提供人文...     

围术期患者焦虑反应的相关因素及干预措施

麻醉、手术对于患者是一种严重的心理应激,它通过心理上的疑惧和生理上的创伤直接影响患者的正常心理活动,并由此对手术后的康复产生影响,甚至决定手术的成败.焦虑和抑郁是心理应激引起的情感变化,现着重对围术期患者的焦虑反应、相关因素及干预措施作以下综述.     

心理干预在围手术期的应用

围手术期心理干预(psychological intervention)是指麻醉医师和手术医师以及相关医务人员在围手术期运用温和、明确、简单、肯定的语言等对患者进行积极的心理疏导,使患者通过自主意识的调节抑制麻醉和手术期间的紧张、焦虑、恐惧、烦躁、抑郁等心理因素,创造良好的心理和生理稳态,积极主动配合麻醉和手术.近年来,围手术期心理干预因能够提供患者术前镇静,稳定术中呼吸循环功能,减轻术中和术后疼痛及不良反应,逐渐得到麻醉医师和手术医师的关注和重视.本文就近年来国内外心理干预在围手术期应用的研究成果进行综述,为临床推广应用心理疗法提供参考.     

加速康复外科理念下机器人结直肠癌根治术后苏醒时间的影响因素分析

目的:探讨在加速康复外科要求下行达芬奇机器人辅助结直肠癌根治术后麻醉苏醒时间的影响因素，为缩短麻醉苏醒时间、加速患者康复提供参考。方法:回顾性收集2021年1月至2022年10月行达芬奇机器人辅助结直肠癌手术的64例患者的病历资料，包括患者的一般情况及围术期指标。采用单因素相关分析及多元线性回归分析的统计学方法得出与苏醒时间相关的影响因素。结果:年龄、术前血红蛋白、术前血糖、腹部手术史及手术时间是此类手术麻醉苏醒时间的影响因素，年龄、术前血红蛋白、术前血糖是其独立影响因素。结论:在加速康复外科理念下，达芬奇机器人辅助结直肠癌根治术后麻醉苏醒时间受多种因素影响，其中年龄、术前血红蛋白、术前血糖是其独立影响因素；围术期应针对相应的影响因素采取各项措施提前干预，以缩短麻醉苏醒时间，提高麻醉复苏质量。     

围术期小儿应激反应因素与调控

目的 小儿围术期应激反应的典型表现是神经内分泌系统、免疫系统和代谢系统的变化.术前焦虑、紧张等心理因素以及麻醉、手术创伤均可影响小儿围术期应激反应,而且应激反应的剧烈程度与围术期并发症的发生率密切相关.目的 通过综述比较,确定更能有效降低小儿围术期应激反应的麻醉药物、麻醉方法和术后镇痛方式.内容 综述小儿围术期应激反应的生物学特点以及小儿围术期心理状况、常用麻醉药物、麻醉方法对围术期应激反应的影响.趋向 深入研究比较不同术后镇痛方式对小儿术后应激反应的影响,以降低小儿术后相关并发症.     

优质精细化术中护理在小儿腹腔镜腹股沟疝手术中的应用效果

目的探究优质精细化护理管理在小儿腹股沟疝手术中的应用效果。 方法选取2020年1月至2021年1月西南医科大学附属医院收治的拟行腹腔镜腹股沟斜疝疝囊高位结扎术的患儿100例,按照随机分组法,分为对照组与研究组,每组50例。对照组予围手术期常规护理干预结合精细化管理,研究组在对照组基础上行优质手术室护理。对比2组患儿干预前、后,患儿住院时间、麻醉清醒时间、并发症发生率、手术效率相关指标、家长与医护人员满意度,进一步分析评价护理效果。 结果研究组患儿术中麻醉清醒时间、住院时间、手术接送时间皆优于对照组（P<0.05）;研究组患儿在进入手术室后焦虑程度显著低于对照组（P<0.05）,且研究组患儿家长满意程度显著高于对照组（P<0.05）。 结论优质护理结合精细化管理应用于手术室护理对行腹腔镜腹股沟斜疝疝囊高位结扎术的患儿效果良好,能明显缩短患儿手术接送时间、住院时间,减轻患儿手术交接、诱导麻醉时的焦虑情绪,提升患儿家长满意度。     

An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery

We attempted to identify specific predictors of preoperative parental anxiety in a population of parents of healthy infants and children undergoing elective, outpatient surgery. We specifically examined the following factors: age of the child, whether or not the child had previous surgery, whether or not the parents>> other children had previous surgery, parental gender, highest level of education obtained by the parent, and whether or not there was prior discussion between the parent and anaesthesiologist. In the immediate preoperative period, a questionnaire (State-Trait Anxiety Inventory) was given to all parents of infants and children presenting for elective, outpatient surgery. Six hundred parents of 417 children, aged two months to 16 years (mean=4.5 years), participated in the study. They included 388 mothers and 212 fathers. Our results indicate that parents are more anxious when their child is less than one year of age and when it is the child's first surgery. When assessed separately by parental gender, both these factors were significant for mothers but not their fathers. We recommend that, although anaesthesiologists generally tailor their preoperative preparation based upon the best needs of their patients and families, they pay special attention to the groups we have identified which are at increased risk for preoperative anxiety.     

Age-specific and family-centered information modalities to prepare children at home for day-care surgery

BackgroundSurgery induced stress and anxiety in children and parents can be reduced by providing preoperative information adapted to their needs. Aim of this study was to evaluate the effects of three different information modalities (coloring page, mobile application and videos) to prepare children and their parents for day-care surgery on preoperative anxiety and postoperative pain experienced by the child, and preoperative anxiety and satisfaction of parents.MethodsProspective observational study including children and their parents that were offered specifically developed information modalities to prepare for day-care surgery. Results were compared between children and their parents that used none (i.e., control group) versus one or more information modalities (i.e., intervention group). Primary outcomes were preoperative anxiety measured using PROMIS v2.0 Anxiety and postoperative pain in children. Secondary outcomes were preoperative parental anxiety (STAI questionnaire) and family satisfaction with information and communication (modified PedsQL Healthcare Satisfaction questionnaire). Subgroup analyses were performed between preschoolers (0-5 years) and school-aged (≥5) children.Results93 patients (male 53%) were included in the intervention (n=56) and control group (n=37). Levels of children's preoperative anxiety and postoperative pain, and parental anxiety did not differ between both groups. Families of prepared children were more satisfied with information and communication about preoperative surgical information (8 vs. 6.6, p=0.004) and satisfaction with how parents (7 vs 8, p=0.019) and children (8 vs 6, p=0.018) were prepared for surgery.ConclusionsPreoperative anxiety did not differ between prepared and unprepared children. The use of specifically developed family-centered and age-appropriate information modalities to prepare children for day-care surgery at home results in superior family satisfaction.Level of EvidenceIII     

Preoperative parental information and parents' presence at induction of anaesthesia

Preoperative preparation of paediatric patients and their environment in order to prevent anxiety is an important issue in paediatric anaesthesia. Anxiety in paediatric patients may lead to immediate negative postoperative responses. When a child undergoes surgery, information about the child's anaesthesia must be provided to parents who are responsible for making informed choices about healthcare on their child's behalf. A combination of written, pictorial, and verbal information would improve the process of informed consent. The issue of parental presence during induction of anaesthesia has been a controversial topic for many years. Potential benefits from parental presence at induction include reducing or avoiding the fear and anxiety that might occur in both the child and its parents, reducing the need for preoperative sedatives, and improving the child's compliance even if other studies showed no effects on the anxiety and satisfaction level. The presence of other figures such as clowns in the operating room, together with one of the child's parents, is an effective intervention for managing child and parent anxiety during the preoperative period.     

Répercussions psychocomportementales en périopératoire chez l’enfant

The relevant literature since the 1940s has been collected from the Medline database, using the keywords: child, operation, anxiety, distress, postoperative complications, preparation, premedication, parental presence, prevention. Preoperative anxiety, emergence delirium, and postoperative behavior changes are all manifestations of psychological distress in children undergoing surgery. Preoperative anxiety is most prominent during anaesthesia induction. Emergence delirium is frequent and somewhat independent of pain levels. Postoperative behavior changes most often include separation anxiety, tantrums, fear of strangers, eating problems, nightmares, night terrors and bedwetting. These difficulties tend to resolve themselves with time but can last up to one year in some children. The major risk factors for postoperative behavior problems are young age, prior negative experience with hospitals or medical care, certain kinds of hospitalization, postoperative pain, parental anxiety, and certain personality traits of the child. Currently, tools exist for quantifying anxiety (m-YPAS) and postoperative behavior (PHBQ). It is possible to identify those children who are at risk for postoperative complications during the preanaesthesia consultation by paying close attention to children under six years with higher levels of emotionality and impulsivity and poorer socialization skills with anxious parents. Suggested strategies for reducing child distress include preoperative preparation, premedication, parental presence during anaesthesia induction, and interventions affecting the child's environment, such as hypnosis. There are numerous ways to provide preoperative preparation (information, modeling, role playing, encouraging effective coping) and their effectiveness is proven in the preoperative setting but not during anaesthesia induction or in the operating room. Midazolam has been shown to be an effective preoperative sedative for reducing anxiety. Parental presence during induction has been shown to effectively reduce preoperative anxiety in children in certain contexts (when the parent is calm and the child is anxious). It is worthwhile if it is integrated into a family-centered anxiety management program and remains one of several options offered to families. Overall, taking into account the child's psychological needs should be considered an essential part of paediatric anaesthesia. Tools and techniques are available for assessing and managing the perioperative distress experienced by children.     

Anaesthesia induction in children: a psychological evaluation of the efficiency of parents' presence

BACKGROUND: The induction of anaesthesia for surgery is a stressful time for both child and parents. To treat preoperative anxiety in children, pharmacological methods (premedication) and behavioural methods (the presence of parents during the induction of anaesthesia) have been used, both independently and in combination. The purpose of this investigation was to study the effect of both premedication and parental presence on preoperative anxiety in a homogeneous population. METHODS: In this study conducted between January and April 2001 in the Meyer Hospital in Florence (Anaesthesia Department and Surgical Department), we studied 39 Italian speaking children aged 2-14 years who were undergoing minor surgery. Before the surgical intervention the State Trait Anxiety Inventory (STAI) questionnaire and a questionnaire for the social-demographic characteristics were given to the parents. The stress of the children was evaluated during induction of anaesthesia. We also studied behavioural areas of both children and parents with two specific questionnaires administered after the surgery. RESULTS: The STAI scores showed that the mothers had a higher level of anxiety compared with the fathers. The induction of anaesthesia for surgery was a stressful time for 23% of children of our sample. The correlation between stress of the child at induction and state (P = 0.034) and trait (P = 0.049) anxiety of parents was statistically significant. The child's loss of consciousness was for the majority of parents (56%) the moment of greatest stress and 97% of parents did feel useful during the induction of anaesthesia. There was a significant difference, P = 0.032, in the presence or absence of stress depending on whether the mother or father accompanied the child to the operating room. There was no significant difference in the presence of stress between children who did and did not receive premedication. CONCLUSIONS: Maternal presence, compared with the father's presence, is fundamental in helping to overcome anxiety in a child receiving anaesthesia. If the parents are present during the induction, the addition of premedication does not offer further benefit. Parents themselves judged their presence during the induction of anaesthesia in their child as a positive event. We also found a statistical significant correlation between anxiety of the parents with the level of the stress of the child during induction of anaesthesia.     

The effect of videotaped preoperative information on parental anxiety during anesthesia induction for elective pediatric procedures

BACKGROUND: The purpose of this study was to determine whether audiovisual information, describing the process of undergoing and recovering from anesthesia, could reduce anxiety levels in parents before their child's induction of anesthesia. METHODS: One hundred and eleven parents were recruited into this study. Of these 56 were randomized to a control group and 55 to an intervention group. All parents completed the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaires on admission to hospital on the day of surgery and then again just before accompanying their child to the anesthetic room. In addition to the normal preoperative preparation, parents randomized into the study group watched a short 8-min information video after completing the first questionnaire. The video illustrated the events and procedures surrounding a child's admission to hospital for day-case surgery, including the induction of anesthesia. RESULTS: The results were analyzed using repeated measures of anova. There was a statistically significant reduction in anxiety and desire for information in the intervention group compared with the control group (P < 0.05). CONCLUSIONS: The reduction in anxiety in the intervention group indicates that preoperative information videos are an effective method of reducing anxiety in parents. Furthermore, the reduction in need for information score in the intervention group indicates that preoperative videos may be a useful tool for providing parents with information.     

Risk factors for anxiety at induction of anesthesia in children: a prospective cohort study

BACKGROUND: In children anxiety at induction of anesthesia is a common and important aspect of the psychological impact of anesthesia and surgery. Previous studies examining risk factors for increased anxiety have found contradictory results. This may be due to using small, or highly selective population samples, or failure to adjust for confounding variables. Results may also be culturally or institutionally specific. The aim of this study was to identify possible risk factors in a large representative cohort of children. METHODS: One thousand two hundred fifty children aged 3-12 years were recruited. Anxiety at induction of anesthesia was assessed using the modified Yale preoperative anxiety scale. Children with an anxiety score of greater than 30 were classified as having high anxiety. Anesthetists were blinded to the assessment. Data recorded included age, gender, past healthcare history, family details, use of sedative premedication, anesthesia details, admission details, parental anxiety and child temperament. An unadjusted analysis was performed to identify possible risk factors for high anxiety. An adjusted regression analysis was then performed including the potential risk factors identified in the unadjusted analysis. RESULTS: The incidence of high anxiety at induction was 50.2%. In the adjusted analysis, younger age, behavioral problems with previous healthcare attendances, longer duration of procedure, having more than five previous hospital admissions and anxious parents at induction were all associated with high anxiety at induction. Hospital admission via the day stay ward was associated with less anxiety. Sedative premedication was associated with less anxiety in children with ASA status greater than one. However, the variability explained by factors included in the model was low (5.3%). CONCLUSIONS: Some simple preoperative questions can help identify children at risk of heightened anxiety at induction of anesthesia; however, it remains difficult to precisely predict which child will experience high anxiety.     

早期心理与信息支持对甲状腺日间手术患者术前应激的影响

目的 减轻甲状腺日间手术患者术前焦虑,稳定生命体征.方法 将78例甲状腺日间手术患者按入院先后顺序分为对照组和干预组各39例.对照组进行常规护理与指导,干预组在此基础上由专职护士于预约手术时、术前3 d、术前1 d、手术日等待手术时进行4次心理与信息支持干预.采用状态焦虑问卷(S-AI)评定患者预约手术时和手术日等待手...     

Preoperative psychological preparation for children undergoing ENT operations: a comparison of two methods

A psychological preparation programme was developed for outpatient surgery in children. The purpose of this study was to determine if the programme could increase retrieval of information and reduce anxiety prior to ENT surgery. After ethical committee approval, 160 children and their parents were included. Eighty children (group 1) received conventional verbal information from an ENT nurse, and another 80 children (group 2) received specific information, including role-play, from a nurse anaesthetist at a preadmission visit. Children's and parents' experience of premedication, operation theatre (OR), i.v.-needle insertion and induction of anaesthesia were evaluated from a self-rating questionnaire. The questionnaire included ratings for anxiety and satisfaction with information and care. The results indicate a clear improvement of the preoperative acquisition of knowledge in all age groups. When it comes to alleviation of fear, a positive effect of the preparation programme was noticed, especially among the younger children (< 5 years), while preoperative anxiety overall was a significantly smaller problem among the older children. The effects of the programme were also related to previous experience of anaesthesia and most beneficial among young children with such experience. Overall, the most negative procedure reported by the children was the i.m. injection for premedication (a routine which was abandoned as a result of the study), followed by the insertion of the i.v. -needle. The parents experienced watching their child fall asleep during induction of anaesthesia as most negative, followed by the insertion of the i.v.-needle. Parents also reported more satisfaction and less anxiety after having received specific information and preparation preoperatively. It was concluded that this preoperative preparation programme is useful in all age groups with regard to information, while alleviation of anxiety and fear was seen mainly among the younger children with previous experience of anaesthesia.     

Parental anxiety before elective surgery in children A British perspective

This study measures the anxiety levels in 100 parents of children scheduled for elective surgery at the Royal Aberdeen Children's Hospital. Anxiety levels were quantified using the Leeds scale for self-assessment of anxiety. Forty-two per cent of parents were significantly anxious. Mothers were identified as being more pathologically anxious than fathers. The 'anxious' parents were specifically more anxious about the surgery, anaesthesia, postoperative pain and treatment, and hospitalisation in general. All parents, whether identified as anxious or not, agreed on factors likely to reduce anxiety: pre-operative information from staff, being able to accompany their child to the operating theatre and being present at induction of anaesthesia.