| 康路,陈倩,王伟,等.多模式围手术期处理对小儿人工耳蜗植入术后恢复的影响研究[J].安徽医药,2020,24(7):1427-1430. |
| 多模式围手术期处理对小儿人工耳蜗植入术后恢复的影响研究 |
| Effects of multi?mode perioperative management on recovery after cochlear implantation in children |
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| DOI：10.3969/j.issn.1009?6469.2020.07.040 |
| 中文关键词: 耳蜗植入术 围手术期医护 安定镇痛 心理护理 多模式 儿童 |
| 英文关键词: Cochlear implantation erioperative care Neuroleptanalgesia Psychological nursing Multimode Child |
| 基金项目:安徽省高校自然科学研究项目(kj2019A1111) |
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| 中文摘要: |
| 目的观察术前通过心理干预、合理禁食水、术前用药、精准麻醉方案以及术后充分镇痛等多模式处理对小儿人工耳蜗术后恢复的影响。方法选择 2014年 2月至 2018年 8月在安徽省第二人民医院择期行人工耳蜗植入术、年龄范围 2~6岁的学龄前儿童 60例，采用随机数字表法将其分为多模式组和对照组，每组 30例。两组病儿术前一天由麻醉医生进行术前访视，与病儿及家属充分沟通，缓解焦虑情绪。术前禁食 4h，禁饮 2h，术前 2h口服 5%葡糖糖水 5 mL/kg。入手术室前由术前访视并的同一麻醉医生根据病儿的焦虑程度准备相应的心理干预，经鼻滴入右美托咪定 1 μg/kg；对照组病儿进行常规术前访视，按照传统的术前禁食水 4~6 h。两组病儿均在准备间开放静脉。入室后予以心电监护，静脉依次注入丙泊酚 1.0～2.0 mg/kg，舒芬太尼 0.15 μg/kg，顺式苯磺酸阿曲库胺 0.1 mg/kg，行气管插管。多模式组手术结束后在切口处涂抹一层复方利多卡因乳膏。病儿清醒拔管后，多模式组病儿近亲属陪同在其身边，两组病儿均在完全清醒后送回病房。如病儿术后 2h无明显不适，可给予少量流质饮食。采用改良耶鲁围术期焦虑量表( modified Yale Perioperative Anxiety Scale，mYPAS)评估病儿在术前即病儿在准备间开放静脉通道时 T1与入手术室时 T2的焦虑程度；记录每组的手术时间、麻醉时间、苏醒时间以及近亲属满意度；采用麻醉苏醒期躁动量化评分表( Pediatric Anesthesia Delirium，PAED)评估病儿在苏醒时的躁动程度和行 Ramsay镇静评分；术后 24 h随访病儿出现不良反应发生的情况。结果与对照组比较，多模式组病儿在开放静脉通道和入手术室时的焦虑程度(38.33±5.10)、(31.25±4.30)分明显低于对照组( 67.92±12.50)、(67.50±12.60)分( P＜0.05)苏醒时 PAED躁动评分( 14.7±2.3)分明显高于多模式组( 7.0±1.6，分)分( P＜0.05)Ramsay镇静评分明显( 2.1±0.9)分低于多组( 4.3±0.9)分( P＜0.05)；多模式组近亲属满意度( 93.3%)明显高于对照组( 53P＜0.05)；两组手术时间、麻醉时间、苏醒时间，以及两者术后不良反应发生模式.3%)(情况，均差异无统计学意义(均 P＞0.05)。结论多模式围手术期处理能有效地应用于小儿人工耳蜗植入术中，可减少麻醉恢复期躁动，利于围术期管理，促进小儿康复，提高了近亲属满意度。 |
| 英文摘要: |
| Objective To investigate the effects of multi?mode perioperative management，including psychological intervention，rea? sonable fasting scheme，appropriatemedication before anesthesia，precision anesthesia strategy，early postoperative feeding and other measures，on the recovery after cochlear implantation in children.Methods A total of sixty children aged 2?6 years who were scheduled for cochlear implantion surgery in The Second People’s Hospital of Anhui Province from February 2014 to August 2018were selected and randomly divided into the multimodal group and the control group.The anesthesiologists conducted preoperativevisits one day before surgery in multimodal group patients，and fully communicated with the children and their families to relieveanxiety.Patients were fasted for 4h and abstained from drinking for 2h，then 5％GS 5 ml/kg were given 2h before operation.Before entering the operating room，the same anesthesiologist who visited preoperatively prepared the corresponding psychological interven?tion according to the anxiety degree of the patient，and nasal infusion of dexmedetomidine 1μg/kg was conducted.Those in group Dreceived routine preoperative interview and traditional anesthesia treatment.The operation time，anesthesia time，recovery time and family satisfaction of each group were recorded.The modified Yale perioperative anxiety scale(mYPAS)was used to evaluate the anxiety level of children at T1 and T2.The degree of agitation was assessed by the pediatric anesthesia delirium(PAED)scale and the Ramsay score at the time point of recovering time were recorded.The adverse effects were evaluated within 24 hours after opera?tion.Results The anxiety scores of the children when opening the venous channel and entering the operating room were(38.33± 5.10)and(31.25±4.30)，which were significantly lower than those of the control group(67.92±12.50)and(67.50±12.60)( P＜0.05).The PAED score at the recovery time of group D was(14.7±2.3)，which was higher than that in the multimodal group(7.0±1.6)，and the Ramsay sedation score of the group D(2.1±0.9)was significantly lower than that of the multimodal group(4.3±0.9)(P＜0.05).The degrees of parental satisfaction of multimodal group(93.3%)were higher than that of group D(53.3%)(P＜0.05). There was no significant difference in the occurrence of postoperative adverse reactions between the two groups(all P＞0.05).Con? clusion Multi?mode perioperative management can be effectively applied in pediatric cochlear implantation to reduce the inci?dence of arousal agitation，facilitate perioperative management，and improve the family satisfaction. |
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