苏醒期谵妄(Emergence Delirium)是学龄前期儿童接受全身麻醉后最常出现的麻醉并发症,出现时间短,但是容易对小儿身心方面都造成严重的后果。随着2017欧洲麻醉学会发布了《基于循证和专家共识的术后谵妄指南》,对于ED的认知也更加系统全面。ED的危险因素包括年龄、术前焦虑程度、疼痛、术前用药等。其防治措施主要分为药物治疗和非药物治疗方法。药物治疗方法已较为成熟,但是用药均伴随着相应的负面影响,所以非药物治疗方法再次被大力推崇,结合飞速发展的现代科技,非药物治疗方法拥有相当光明的研究前景,相信以非药物治疗为主导,辅助以适当的药物治疗,将会成为未来对小儿苏醒期谵妄防治的主流趋势。
Emergence delirium (ED) is the most common complication of preschoolers who received general anesthesia. Although ED lasts not long but it could cause severe effects on both physical and mental. After the publication of European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium, we know better about ED. The risk factors contain age, preoperative anxiety, pain, premedicate etc. Medicine and non-medicine treatment are two main solutions and the medicine treatment has been used perfectly, but we cannot avoid all the side effects of medicines. So non-medicine treatment becomes more and more important recently. When it combined with modern technic and proper medicine treatment, we believe that such method will become a main trend to prevent and cure ED in pediatric patients.
全身麻醉,苏醒期谵妄,小儿, General Anesthesia Emergence Delirium Child摘要
Emergence delirium (ED) is the most common complication of preschoolers who received general anesthesia. Although ED lasts not long but it could cause severe effects on both physical and mental. After the publication of European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium, we know better about ED. The risk factors contain age, preoperative anxiety, pain, premedicate etc. Medicine and non-medicine treatment are two main solutions and the medicine treatment has been used perfectly, but we cannot avoid all the side effects of medicines. So non-medicine treatment becomes more and more important recently. When it combined with modern technic and proper medicine treatment, we believe that such method will become a main trend to prevent and cure ED in pediatric patients.
在ESA指南中,使用ADVANCE认知准备策略和非药物疗法被列为防治患儿ED的B推荐等级措施,其中ADVANCE认知准备策略在减少PAED发生率方面优于预防性咪达唑仑,其主要内容为:Anxiety-reduction(减少焦虑)、Distraction on the day of surgury (恐惧焦虑的转移)、Video modeling and education (术前视频建模及教育)、Adding parents (父母和家庭参与手术体验)、Noexcessive reassurance (避免过多的安慰)、Coaching of parents by staff (指导父母配合麻醉医生)、Exposure/shaping of the child via mask practice (小儿熟悉面罩),Kain ZN等 [45] 在2007年便通过一项随机对照临床试验证实了其对于减少小儿ED的效果。近年有研究患儿母亲录音对患儿的影响,这是第一个研究母亲录音对ED影响的随机对照研究 [46]。Pan Y等 [47] 研究发现通过术前对患儿的蒙眼训练可以减少苏醒期焦虑、疼痛和谵妄的发生率。还有外国学者研究使用沉浸式虚拟现实技术(VR)对患儿ED的影响,虽然结果显示其仅能减少术前焦虑,不能减少谵妄的发生率及其严重程度 [48],但这项研究无疑为广大麻醉医师使用现代科学技术来解决患儿ED打开了新思路。
常翰轩,胡 彬. 小儿全身麻醉苏醒期谵妄的研究进展The Research Process of Postanesthetic Emergence Delirium in Pediatric Patients under General Anesthesia[J]. 医学诊断, 2020, 10(03): 117-125. https://doi.org/10.12677/MD.2020.103019
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