眼科和耳鼻喉科手术患儿出现躁动的患病率及危险因素：一项横断面研究。
Prevalence and risk factors of emergence agitation among pediatric patients undergo ophthalmic and ENT Surgery: a cross-sectional study.
机构信息
Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China.
Department of Anesthesiology, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, China.
出版信息
BMC Pediatr. 2023 Nov 24;23(1):598. doi: 10.1186/s12887-023-04434-y.
BACKGROUND
Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children with EA tend to carry the risk of self-harm, have longer periods of recovery and delayed hospital discharge. Consequently, EA needs to be monitored and risk factors ought to be emphasized to implement preventative measures. The objective of this study was to describe EA and to identify risk factors after pediatric ophthalmic or ENT surgery.
METHODS
Between September 2021 and December 2021, a cross-sectional study was conducted in 100 children aged of 0-12 years who underwent ophthalmic or ENT surgery. The Watcha scale was used to observe and record EA, which was defined at levels of 3 or 4 at any time in the post-anesthesia care unit (PACU). The pain intensity was graded with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale after surgery. Patient and surgery-related characteristics, the behavioral criteria of EA, the pharmacologic and non-pharmacologic interventions and recovery outcomes were objectively recorded. A binary logistic regression model was constructed to identify the associated factors of EA.
RESULTS
From the 100 analyzed children, 58 were males and 42 were females, and 44 patients received ophthalmic surgery and 56 ENT surgery. The median age was 6 (IQR 4-7) years. The overall incidence of EA among pediatrics was 30% (34.5% for ENT and 24.4% for ophthalmic surgery). High preoperative modified Yale Preoperative Anxiety scale (m-YPAS) grade (OR = 1.19, 95%CI 1.06-1.33, P = 0.003) and high postoperative FLACC score (OR = 3.36, 95%CI 1.88-6.02, P < 0.001) were risk factors for EA.
CONCLUSIONS
This study identified that preoperative anxiety and postoperative pain are associated with EA in children after ophthalmic or ENT surgery. Preoperative anxiety assessment and management, and administration of adjunct analgesic treatments should be considered in the routine care.
背景
一些研究报告称，接受耳鼻喉（ENT）和眼科手术的儿科患者出现术后躁动（EA）的发生率较高。患有 EA 的儿童往往有自我伤害的风险，恢复期较长，出院时间延迟。因此，需要对 EA 进行监测，并强调危险因素以实施预防措施。本研究旨在描述儿科眼科或 ENT 手术后的 EA，并确定危险因素。
方法
本研究于 2021 年 9 月至 12 月进行了一项横断面研究，共纳入 100 名 0-12 岁接受眼科或 ENT 手术的儿童。采用 Watcha 量表观察和记录 EA，在麻醉后护理单元（PACU）的任何时间任何级别达到 3 或 4 级时定义为 EA。术后采用面部、腿部、活动、哭泣、安抚（FLACC）量表对疼痛强度进行分级。客观记录患者和手术相关特征、EA 的行为标准、药物和非药物干预以及恢复结果。构建二项逻辑回归模型来识别 EA 的相关因素。
结果
在分析的 100 名儿童中，58 名男性，42 名女性，44 名接受眼科手术，56 名接受 ENT 手术。中位年龄为 6（IQR 4-7）岁。儿科 EA 的总体发生率为 30%（ENT 为 34.5%，眼科手术为 24.4%）。术前改良耶鲁术前焦虑量表（m-YPAS）评分较高（OR=1.19，95%CI 1.06-1.33，P=0.003）和术后 FLACC 评分较高（OR=3.36，95%CI 1.88-6.02，P<0.001）是 EA 的危险因素。
结论
本研究发现，术前焦虑和术后疼痛与儿童眼科或 ENT 手术后的 EA 有关。在常规护理中应考虑术前焦虑评估和管理，并给予辅助镇痛治疗。
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