Massoth Gregor, Vorhofer Emma, Spuck Nikolai, Mikus Marian, Mini Nathalie, Strassberger-Nerschbach Nadine, Wittmann Maria, Neumann Claudia, Schindler Ehrenfried
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany.
Cardiol Young. 2024 Nov;34(11):2437-2444. doi: 10.1017/S1047951124025757. Epub 2024 Oct 2.
Cardiac catheterisation is crucial for diagnosing and treating paediatric heart diseases, but it is poorly tolerated by small children, infants, and newborns without sedation. This study investigated whether maternal voice during sedation could lower stress and pain in children undergoing cardiac catheterisation and also assessed mothers' stress levels before and after the procedure.
This was a prospective, monocentric, randomised, controlled interventional study at the University Hospital Bonn. Children aged 4 years or younger scheduled for elective cardiac catheterisation under procedural sedation and American Society of Anaesthesiologists class between 1 and 3 were eligible.
At the end of cardiac catheterisation, the intervention group showed a higher Newborn Infant Parasympathetic Evaluation index with an adjusted mean difference of 9.5 (± 4.2) ( = 0.026) and a lower median Children's and Infants Postoperative Pain Scale score of 2.0 (IQR: 0.0-5.0) versus 4.5 (IQR: 3.0-6.0) than the control group ( = 0.027). No difference in the children's cortisol level was found ( = 0.424). The mothers in the intervention group had a lower cortisol level than those in the control group before cardiac catheterisation (adjusted mean difference: -4.5 nmol/l (± 1.8 nmol/l), = 0.011).
Listening to the maternal voice during cardiac catheterisation could lead to less postoperative pain and significantly lower stress and discomfort level in children. Less pain could reduce the incidence of postoperative delirium.Additionally, mothers perceived involvement as positive. A reduced stress level of mothers can positively influence children and possibly reduce pain and anxiety.
心导管检查对于小儿心脏病的诊断和治疗至关重要，但对于未使用镇静剂的幼儿、婴儿和新生儿而言，他们对该检查的耐受性较差。本研究调查了在镇静过程中母亲的声音是否能减轻接受心导管检查儿童的应激和疼痛，并评估了手术前后母亲的应激水平。
这是一项在波恩大学医院进行的前瞻性、单中心、随机对照干预研究。年龄在4岁及以下、计划在程序镇静下进行择期心导管检查且美国麻醉医师协会分级为1至3级的儿童符合入选标准。
在心导管检查结束时，干预组的新生儿副交感神经评估指数更高，调整后的平均差异为9.5（±4.2）（P = 0.026），儿童和婴儿术后疼痛量表评分中位数更低，为2.0（四分位间距：0.0 - 5.0），而对照组为4.5（四分位间距：3.0 - 6.0）（P = 0.027）。未发现儿童皮质醇水平存在差异（P = 0.424）。干预组母亲在心导管检查前的皮质醇水平低于对照组（调整后的平均差异：-4.5 nmol/l（±1.8 nmol/l），P = 0.011）。
在心导管检查过程中聆听母亲的声音可减轻儿童术后疼痛，并显著降低其应激和不适水平。疼痛减轻可降低术后谵妄的发生率。此外，母亲们认为参与其中是积极的。母亲应激水平的降低可对儿童产生积极影响，并可能减轻疼痛和焦虑。
