Beyond pain: predictors of postoperative maladaptive behavior change in children
Beyond pain: predictors of postoperative maladaptive behavior change in children
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DOI：
10.1111/j.1460-9592.2010.03281.x
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发表时间：
2010-05-01
影响因子：
1.7
通讯作者：
Kain, Zeev N.
中科院分区：
文献类型：
--
作者：
Fortier, Michelle A.;Del Rosario, Antonio M.;Kain, Zeev N.
目的与目的：采用有效的测量方法，并控制潜在的混杂变量，如疼痛、手术和麻醉技术，本项目的目标是确定手术后儿童行为改变的发生率和危险因素。背景：尽管研究人员描述了手术后的适应不良行为改变，但许多先前的研究受到潜在混杂变量的限制，包括术后疼痛、手术类型、手术和麻醉程序。方法：参与者包括260名接受扁桃体切除术和腺样体切除术的儿童。术前收集基线和人口统计数据，术后2周记录疼痛和行为恢复情况。采用标准化的麻醉和手术方法，并采用有效的评估措施。结果：术后回家第一天，80.4%的患儿表现出不良行为改变。近三分之一的儿童在手术后两周仍表现出行为改变。控制疼痛严重程度的Logistic回归分析确定了行为改变的几个预测因素：先前存在的躯体和焦虑/抑郁问题预测术后新发的一般性焦虑，chi 2 (8) = 20.10, P = 0.010；年龄越小预测分离焦虑，chi 2 (4) = 20.41, P < 0.01；抑制气质预测术后睡眠障碍，chi 2 (2) = 9.19, P = 0.010。结论：疼痛以外的儿童个体因素可预测术后不良行为改变；识别这些预测因素可能有助于预防和改善手术后行为恢复的困难。
P>Objectives & Aim:Using well-validated measures and controlling for potential confounding variables such as pain and surgical and anesthetic technique, the goal of this project was to identify the incidence of and risk factors for the development of behavior change in children after surgery.Background:Although researchers have described maladaptive behavior change following surgery, many previous studies are limited by potential confounding variables, including postoperative pain, type of surgery, and surgical and anesthetic procedure.Methods:Participants included 260 children undergoing tonsillectomy and adenoidectomy. Baseline and demographic data were collected prior to surgery and pain and behavioral recovery were recorded for 2 weeks following surgery. A standardized approach to anesthesia and surgical procedure was implemented and well-validated assessment measures were used.Results:On the first day at home following surgery, 80.4% of children exhibited negative behavior change. Nearly one-third of children continued to exhibit behavior changes 2 weeks after surgery. Logistic regression analyses that controlled for pain severity identified several predictors of behavior change: preexisting somatic and anxious/depressed problems predicted new onset postoperative general anxiety, chi 2 (8) = 20.10, P = 0.010; younger age predicted separation anxiety, chi 2 (4) = 20.41, P < 0.01; and inhibited temperament predicted postoperative sleep disturbance, chi 2 (2) = 9.19, P = 0.010.Conclusions:Individual child factors above and beyond pain predict maladaptive postoperative behavior change; identification of these predictors may be helpful in both preventing and ameliorating difficulties with behavioral recovery following surgery.