一项观察性研究：腺样体切除术后两周内小儿出现谵妄与术后早期消极行为增加有关。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY Brazilian Journal of Anesthesiology Pub Date : 2024-09-01 DOI:10.1016/j.bjane.2021.03.008

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引用次数: 0

摘要

研究背景这项前瞻性多中心观察研究旨在测量小儿术后谵妄的发生率，并调查学龄前儿童在门诊腺样体切除术后两周内术后早期负面行为的发生率：研究对象包括 222 名患者（1-7 岁）。所有患儿均接受了多模式麻醉，即使用丙泊酚和瑞芬太尼联合吡瑞匹胺（0.1 毫克.千克-1）、布洛芬（10 毫克.千克-1）、地塞米松（0.15 毫克.千克-1）和开他尼特 S（0.1 毫克.千克-1）进行全静脉麻醉。我们使用小儿麻醉谵妄量表（PAED）在恢复期的不同预定时间点对谵妄进行评估。在前三个标准中，PAED评分≥9分为出现谵妄。此外，当住院后行为问卷的 27 项标准中至少有 5 项呈阳性时，我们将其定义为术后早期负面行为：结果：采用我们的麻醉方法后，出现谵妄的发生率为 23%。在出现谵妄的患者中，术后早期负面行为的发生率明显更高（24% 对 11%，P = 0.04）。在术后早期负面行为调查问卷中，"睡眠障碍 "和 "分离焦虑 "这两个类别被认为是最常见的术后负面行为变化：结论：新出现的谵妄不仅在手术后立即发挥作用，而且还与门诊腺样体切除术后两周内的术后早期负面行为有关。应告知家长，如果术后出现谵妄，每 4 名患者中就有 1 人可能出现术后早期负面行为：DRKS - 德国临床试验注册编号：DRKS00013121.

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Pediatric emergence delirium is linked to increased early postoperative negative behavior within two weeks after adenoidectomy: an observational study

Background

The aim of this prospective multicenter observational study was to measure the incidence of postoperative pediatric emergence delirium and to investigate the occurrence of early postoperative negative behavior within two weeks after outpatient adenoidectomy in preschool children.

Methods

The study comprised 222 patients (1...7 years of age). All children received a multimodal anesthesia based on total intravenous anesthesia with propofol and remifentanil in combination with piritramid (0.1 mg.kg^-1), ibuprofen (10 mg.kg^-1), dexamethason (0.15 mg.kg^-1), and ketanest S (0.1 mg.kg^-1). We evaluated emergence delirium using the Pediatric Anesthesia Emergence Delirium Scale (PAED) at different predefined time points during the recovery period. Emergence delirium was defined as a PAED score ... 9 for the first three criteria. Additionally, we defined early postoperative negative behavior to be present when at least 5 of 27 criteria of the post hospitalization behavior questionnaire were positive.

Results

The incidence of emergence delirium following our anesthetic regime was 23%. The incidence of early postoperative negative behavior was significantly higher among patients with emergence delirium (24% vs. 11%, p = 0.04). The two categories, ..úsleep disturbance..Ñ and ..úseparation anxiety..Ñ, tested within the questionnaire for early postoperative negative behavior, were identified as the most common postoperative negative behavioral changes.

Conclusion

Emergence delirium not only plays a role immediately after surgery but is also linked to early postoperative negative behavior within two weeks after outpatient adenoidectomy. Parents should be informed that early postoperative negative behavior may occur in 1 out of 4 patients if emergence delirium was present postoperatively.