儿童麻醉诱导期间减轻焦虑的非药物干预措施：一项系统评价和贝叶斯网络荟萃分析
Nonpharmacological interventions for decreasing anxiety during anesthesia induction in children: a systematic review and Bayesian network meta-analysis.
作者信息
Li Yuanyuan, Peng Shanshan, Xia Xueqin, Yin Lin, Liao Limei
机构信息
Department of Radiotherapy for Head and Neck Tumors, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.
Department of Obstetrics and Gynecology, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
BMC Anesthesiol. 2025 May 3;25(1):226. doi: 10.1186/s12871-025-03077-z.
BACKGROUND
Anxiety during anesthesia induction can lead to various negative outcomes and psychological burdens in children undergoing surgery. Nonpharmacological interventions are available for reducing anxiety in this context. However, due to a lack of evidence from head-to-head randomized controlled trials (RCTs), the specific effects of these methods on children with anxiety during anesthesia induction remain unclear.
OBJECTIVE
This network meta-analysis aimed to evaluate the comparative effects of all known nonpharmacological interventions for reducing anxiety in children during anesthesia induction and to rank these interventions based on their practical applicability.
DESIGN
Systematic review and Bayesian network meta-analysis.
METHODS
We searched PubMed, Embase, CINAHL, Cochrane Library, and Web of Science to identify articles published up to August 2024. Two reviewers independently assessed eligibility of potential studies and extracted data. Outcome measures of the meta-analysis were the anxiety levels of children during anesthesia induction, the anxiety levels of parents, and the child's compliance during anesthesia induction. A consistency model was selected to conduct a network meta-analysis to evaluate the relative effects and rank probabilities of different nonpharmacological interventions.
RESULTS
A total of 34 RCTs with 3,040 participants and six intervention methods were included. All trials confirmed the safety of the six intervention methods, with no significant adverse events reported. The network meta-analysis showed that the Passive Distraction Intervention (PDI)-Parental Presence at Induction of Anesthesia (PPIA), Interactive Distraction Intervention (IDI)-PPIA, IDI, PDI, and PPIA interventions were associated with more substantial reductions in anxiety than usual care. However, the studied interventions showed no statistically significant differences for reducing parental anxiety. The PPIA, IDI, and IDI-PPIA interventions also improved compliance during anesthesia induction.
CONCLUSIONS
Our study confirmed that some nonpharmacological interventions are effective at reducing anxiety in children and enhancing compliance during anesthesia induction. Therefore, we recommend several interventions for clinical practice, including the PDI-PPIA, IDI-PPIA, PDI, IDI, and PPIA when working with children undergoing anesthesia induction.
REGISTRATION
We registered this network meta-analysis with PROSPERO (registration no. CRD42022262874).
CLINICAL TRIAL NUMBER
Not applicable.
背景
麻醉诱导期间的焦虑会给接受手术的儿童带来各种负面后果和心理负担。在这种情况下，非药物干预可用于减轻焦虑。然而，由于缺乏来自头对头随机对照试验（RCT）的证据，这些方法对麻醉诱导期间焦虑儿童的具体效果仍不清楚。
目的
本网络荟萃分析旨在评估所有已知的非药物干预措施对减轻儿童麻醉诱导期间焦虑的比较效果，并根据其实际适用性对这些干预措施进行排名。
设计
系统评价和贝叶斯网络荟萃分析。
方法
我们检索了PubMed、Embase、CINAHL、Cochrane图书馆和Web of Science，以识别截至2024年8月发表的文章。两名审稿人独立评估潜在研究的资格并提取数据。荟萃分析的结果指标是儿童麻醉诱导期间的焦虑水平、家长的焦虑水平以及儿童麻醉诱导期间的依从性。选择一致性模型进行网络荟萃分析，以评估不同非药物干预措施的相对效果和排名概率。
结果
共纳入34项RCT，3040名参与者，6种干预方法。所有试验均证实了这6种干预方法的安全性，未报告明显不良事件。网络荟萃分析表明，被动分散注意力干预（PDI）-麻醉诱导时家长在场（PPIA）、互动分散注意力干预（IDI）-PPIA、IDI、PDI和PPIA干预与比常规护理更显著地减轻焦虑有关。然而，所研究的干预措施在减轻家长焦虑方面没有统计学上显著差异。PPIA、IDI和IDI-PPIA干预也提高了麻醉诱导期间的依从性。
结论
我们的研究证实，一些非药物干预措施在减轻儿童焦虑和提高麻醉诱导期间的依从性方面是有效的。因此，我们推荐几种干预措施用于临床实践，包括在处理接受麻醉诱导的儿童时采用PDI-PPIA、IDI-PPIA、PDI、IDI和PPIA。
注册
我们在PROSPERO上注册了这项网络荟萃分析（注册号CRD42022262874）。
临床试验编号
不适用。
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