Mahajan L, Wyllie R, Steffen R, Kay M, Kitaoka G, Dettorre J, Sarigol S, McCue K
Section of Pediatric Gastroenterology and Nutrition, Cleveland Clinic Foundation, OH 44195, USA.
J Pediatr Gastroenterol Nutr. 1998 Aug;27(2):161-5. doi: 10.1097/00005176-199808000-00006.
Like adults, children often experience anxiety associated with medical procedures. The purpose of this study was to investigate the effects of a program of psychological preparation for children undergoing endoscopy.
Sixty patients aged 6 to 19 years (mean, 12.2 years) were randomized into one of two groups. Group 1 received routine preparation before endoscopy. Group 2 received psychological preparation consisting of demonstration of materials that would be encountered during the procedure, use of a doll as a model, or use of a book with photographs of a child who had previously undergone endoscopy. Patients in both groups completed the Spielberger State-Trait Anxiety Inventory in the clinic and just before endoscopy. The Observational Scale of Behavioral Distress was completed by a blinded observer during each procedure. The attending physician (blinded) assessed patient cooperation. Vital signs were recorded in clinic and just before endoscopy. Parents and patients completed questionnaires after endoscopy.
Analysis of the Spielberger State-Trait Anxiety Inventory showed patients in group 2 were significantly less anxious before endoscopy (p < 0.0001). They also required less meperidine (p < eq 0.04) per kilogram body weight and were more cooperative during the examination (p = 0.042). There was significantly less autonomic nervous system stimulation in those who had undergone psychological preparation (change in heart rate, p < 0.001; change in systolic blood pressure, p = 0.04). Statistically significant differences were found in the patients' response to questions after endoscopy regarding perceived anxiety during the procedure (p = 0.003) and the parents' response to questions regarding their own conditions (p = 0.026) and that of their child (p < 0.001).
Psychological preparation before endoscopy significantly decreases patient and parental anxiety. Such preparation may allow for a reduction in sedative medications and thereby enhance procedural safety.
与成人一样，儿童在接受医疗程序时也常常会感到焦虑。本研究的目的是调查一项针对接受内窥镜检查儿童的心理准备计划的效果。
60名年龄在6至19岁（平均12.2岁）的患者被随机分为两组。第1组在接受内窥镜检查前接受常规准备。第2组接受心理准备，包括展示检查过程中会遇到的物品、使用玩偶作为模型，或使用一本有先前接受过内窥镜检查儿童照片的书。两组患者均在诊所及即将进行内窥镜检查前完成斯皮尔伯格状态-特质焦虑量表。在每次检查过程中，由一位不知情的观察者完成行为痛苦观察量表。主治医生（不知情）评估患者的配合情况。在诊所及即将进行内窥镜检查前记录生命体征。家长和患者在检查后完成问卷调查。
对斯皮尔伯格状态-特质焦虑量表的分析显示，第2组患者在接受内窥镜检查前焦虑程度明显较低（p < 0.0001）。他们每公斤体重所需的哌替啶也较少（p < 0.04），并且在检查过程中更配合（p = 0.042）。接受心理准备的患者自主神经系统受到的刺激明显较少（心率变化，p < 0.001；收缩压变化，p = 0.04）。在内窥镜检查后患者对有关检查过程中感知到的焦虑问题的回答（p = 0.003）以及家长对有关自身状况（p = 0.026）及其孩子状况（p < 0.001）问题的回答中发现了统计学上的显著差异。
内窥镜检查前的心理准备可显著降低患者和家长的焦虑。这种准备可能有助于减少镇静药物的使用，从而提高检查过程的安全性。
