医药学论文：手术麻醉对不同个性特征儿童心理行为的影响

【摘要】目的 探讨手术麻醉对不同性格特征的学龄期儿童产生的心理影响及行为改变情况。方法 选择择期腺样体或扁桃体切除术患儿53例，ASAⅠ～Ⅱ级，年龄5～12岁。术前对所有患儿进行艾森克个性问卷（幼儿版）（Eysenk Personal Questionare，EPQ）测试，根据情绪的稳定性，即N维度将患儿分为两组：N>50为情绪不稳定组（C组），N< 50为情绪稳定组（S组）。两组患儿均以异丙酚、芬太尼和万可松静脉诱导，气管内插管，氧气－笑气－异氟醚吸入维持。测试内容：于术前1天、手术当日诱导前和术后1天分别进行改良耶鲁儿童焦虑评分(mYALE)；麻醉诱导时进行诱导期合作评分(ICC)；术毕进行苏醒期躁动评分(PAED)，术后1周及1个月进行术后行为量表评估(PHBO)。结果 两组术前mYALE焦虑评分差异无显著性，但C组患儿在诱导前和术后的评分高于S组，差异有显著性；C组的ICC评分及PAED评分高于S组（P＜0.05）；术后1周行为改变C组高于S组（P＜0.05），术后1个月时行为改变两组差异无显著性，同时两组术后第1周行为适应不良现象均高于术后1个月。结论 与情绪稳定性好的患儿相比，情绪稳定性差的患儿术前易出现紧张、焦虑情绪，以诱导前最为明显，而且这些患儿诱导期合作较差，苏醒期发生躁动的趋势较明显，术后易发生行为适应不良现象，特别在术后第1周更为明显。

 

　　【关键词】 手术麻醉； 性格特征； 学龄儿童； 心理行为

 

　　Anesthetic effects on childrens' psycho-behavior of different personality characteristics

 

　　　【Abstract】 Objective To investigate the effect on psycho-behavior of children in different personality characteristics.Methods 53 ASAⅠ～Ⅱcases of children undergoing tonsillectomy or adenoidectom were randomly selected and divided into two groups according to Eysenck Personal Questionnaire(children): children with N>50, which means unstable emotion, as C group, while those with N< 50, which means stable emotion, as S group. All children were induced with propofol, norcuron and fentanyl, after tracheal intubation, anesthesia were maintained with isoflurane-N2O-O2. Items tested: modified Yale Anxiety Score(mYALE) were tested at three time points: the day before surgery, entering the operating room and the day after surgery; Induction Compliance Checklist(ICC) were tested during induction period; Pediatric anesthesia emergence delirium (PAED) were tested after surgery and post hospital behavior questionnaire(PHBQ) were tested one week and one month after surgery.Results There were no significant difference on mYALE between the two groups before surgery, but during induction period and after surgery mYALE were much higher on C group; The Induction Compliance Checklist showed high score in C group, and also the PAED score after surgery; The incidence of behavior change were higher in C group one week after surgery, but no significant different between two groups after one month.Conclusion Unlike the children with stable emotion, children in unstable emotion showed high level of anxiety before surgery especially during induction period. These kind of children also showed bad cooperation, tendency of restlessness after surgery and more incidence of behavior change, especially during the first week after surgery.

 

　　【Key words】 operative anesthesia;personality characteristics;children;psycho-behavior

 

　　对儿童患者来说，围术期是他们要经历的一个特殊时期；由于自身疾病造成的痛苦，加之认知能力有限，自控能力差，在紧张的医疗氛围中，约有65%的孩子可能发生术前焦虑［1］，12%～18%的孩子可能会出现苏醒期躁动现象［2］，同时50％的孩子可能会发生术后行为适应不良［1］。有报道证实，过分紧张、焦虑不但影响患儿的身心健康，还阻碍患儿在治疗过程中的配合，对术后恢复及心身恢复极为不利。目前，这些临床现象的发生程度是否和患儿本身不同的个性特性有关，国内外尚无报道，就此我们进行了一系列探讨研究，以便为临床工作提供参考依据。