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使用平板电脑对手术应激的影响:一项单盲随机对照试验。

The effect of using tablet computer on surgical stress: A single-blinded randomized controlled trial.

机构信息

Department of Anesthesiology and Reanimation, University of Health Sciences, Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey.

Department of Pediatric Surgery, University of Health Sciences, Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey.

出版信息

J Pediatr Urol. 2022 Jun;18(3):340.e1-340.e9. doi: 10.1016/j.jpurol.2022.03.008. Epub 2022 Mar 15.

Abstract

INTRODUCTION

The purpose of our study was to evaluate the effects of tablet computer method on children with and without anxiety. The study was designed as a prospective single-blinded randomized controlled trial.

MATERIALS AND METHODS

The population of the study were 300 patients between the ages of 4 and 10 years old who were scheduled for their first elective surgery for phimosis-inguinal hernia-hydrocele-undescended testis-hypospadias. The initial anxiety scores of the patients were evaluated using modified-Yale Preoperative Anxiety Scale (mYPAS). Group-Midazolam, Group-Tablet, Group-Control were formed by applying randomization to the patients. The anxiety levels of the patients were evaluated in the waiting room using mYPAS after 0.5 mg/kg midazolam or tablet computer. Patient anxiety about separation from their families was evaluated with Parental Separation Anxiety Scale (PSAS), and reactions to the anaesthesia mask were evaluated with Mask Acceptance Scale (MAS). Also, the time spent by the patients in the Post-Operative Care Unit (PACU) was evaluated. Post-Hospitalization Behavior Questionnaire (PHBQ) scores of the patients were determined by the anesthesiologist one week after the surgery.

RESULTS

The study compared the anxiety levels in groups. There were significant differences in the post-anxiolytic-mYPAS-scores and percentages of decrease from the preoperative baseline measurements (p < 0.001 and p < 0.001). There were significantly more children who were easily separated from their parents (PSAS-Score 1) in Group-Midazolam (p < 0.01). The children in Group-Midazolam also accepted the masks more readily (MAS-Score 1) than other (p < 0.001). Differences in the duration of the recovery time and mean PHBQ-scores between the groups were also significant (p < 0.001 for each). For children with anxiety, the recovery time for those in Group-Midazolam was significantly longer than other. For children without anxiety (p < 0.001), the duration of the recovery time in Group-Midazolam was also found to be significantly longer than other. The PHBQ-scores of the children in Group-Control with anxiety and without anxiety were significantly higher than other (p < 0.05 for each). Also, there were significant differences in the distribution of the PSAS-scores between the children with and without anxiety. Anxiety had no impact on the distribution of the MAS-scores (p = 0.045 and p = 0.100).

CONCLUSION

Playing tablet-based games in the preoperative period enabled pediatric patients to be more comfortable while waiting in their rooms, leaving their families, and applying an anaesthetic mask. In pediatric patient with and without anxiety, midazolam separation from the family and accepting the anesthesia mask is easiest in midazolam, second in those who are given a tablet computer.

摘要

简介

本研究旨在评估平板电脑方法对伴或不伴焦虑的儿童的影响。该研究设计为前瞻性单盲随机对照试验。

材料和方法

本研究的研究人群为 300 名 4 至 10 岁的患者,他们计划进行首次择期手术治疗包茎-腹股沟疝-鞘膜积液-隐睾-尿道下裂。患者的初始焦虑评分采用改良耶鲁术前焦虑量表(mYPAS)进行评估。通过对患者进行随机分组,形成咪达唑仑组(Group-Midazolam)、平板电脑组(Group-Tablet)和对照组(Group-Control)。在给予 0.5mg/kg 咪达唑仑或平板电脑后,在等候室使用 mYPAS 评估患者的焦虑水平。使用父母分离焦虑量表(PSAS)评估患者与家人分离的焦虑程度,使用面罩接受量表(MAS)评估患者对麻醉面罩的反应。还评估了患者在术后护理单元(PACU)中的停留时间。术后一周,麻醉师通过术后住院行为问卷(PHBQ)评估患者的评分。

结果

本研究比较了各组的焦虑水平。与术前基线测量相比,使用焦虑后-mYPAS 评分和下降百分比有显著差异(p<0.001 和 p<0.001)。在咪达唑仑组中,有更多的儿童更容易与父母分离(PSAS 评分 1)(p<0.01)。咪达唑仑组的儿童也更容易接受面罩(MAS 评分 1)(p<0.001)。组间恢复时间和平均 PHBQ 评分的差异也具有统计学意义(p<0.001)。对于有焦虑的儿童,咪达唑仑组的恢复时间明显长于其他组。对于无焦虑的儿童(p<0.001),咪达唑仑组的恢复时间也明显长于其他组。有焦虑和无焦虑的对照组儿童的 PHBQ 评分明显高于其他组(p<0.05)。此外,焦虑儿童和无焦虑儿童的 PSAS 评分分布也存在显著差异。焦虑对 MAS 评分的分布没有影响(p=0.045 和 p=0.100)。

结论

在术前期间使用基于平板电脑的游戏使儿科患者在房间内等待、与家人分离和使用麻醉面罩时更加舒适。在有焦虑和无焦虑的儿科患者中,咪达唑仑最容易使患者与家人分离并接受麻醉面罩,其次是给予平板电脑的患者。

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