Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors
Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors
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DOI：
10.1213/01.ane.0000136471.36680.97
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发表时间：
2004-12-01
影响因子：
5.7
通讯作者：
Zhang, HP
中科院分区：
文献类型：
--
作者：
Kain, ZN;Caldwell-Andrews, AA;Zhang, HP
基于先前的研究，我们假设术前焦虑、苏醒期谵妄和术后适应不良行为改变的临床现象密切相关。我们使用我们实验室在过去6年中获得的数据研究了这个问题。仅招募了接受手术和使用七氟烷/O-2/N2 O全身麻醉且未接受咪达唑仑的儿童。术前采用改良的耶鲁术前焦虑量表（mYPAS）评估儿童的焦虑，在麻醉后监护室评估出现谵妄，并在术后第1、2、3、7和14天采用医院行为问卷（PHBQ）评估行为变化。回归分析显示，儿童的状态焦虑评分（mYPAS）每增加10分，出现明显谵妄症状的几率增加10%。与无苏醒期谵妄症状的儿童相比，具有显著苏醒状态的儿童发生新的术后适应不良行为变化的比值比为1.43。状态焦虑分数增加10分，导致手术后儿童出现新的适应不良行为变化的几率增加12.5%。这一发现对于临床医生来说非常重要，他们现在可以根据术前焦虑水平预测术后不良现象的发展，如出现谵妄和术后行为变化。
Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O-2,/N2O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.