Psychological Influences on Postoperative Recovery

描述(由申请人提供)：这项竞争性延续研究旨在扩展一项正在进行的纵向项目(R01HD37007-01)，研究在接受手术的儿童群体中，术前焦虑与术后行为和临床恢复之间的关系。美国有500多万儿童接受手术。据估计，这些儿童中高达75%的人在手术前出现极度焦虑。在成人中，高度的术前焦虑已被证明与术后的临床结果相关，如疼痛和止痛药需求，以及恢复时间和住院时间的延长。在儿童中，排除了我们最初应用的数据，没有同行评议的发表的结果数据，关于术前行为应激和焦虑是否会损害术后恢复的问题。这一问题非常重要，因为有几种有效的干预措施可用于治疗儿童的术前焦虑。不幸的是，目前有减少这些术前干预的强烈趋势。这一趋势很可能是由于目前的医疗经济环境以及儿童缺乏记录术前焦虑和术后恢复之间联系的结果数据所致。在我们的初步应用中，我们已经证明，儿童高水平的术前焦虑与术后疼痛增加和临床和行为恢复受损有关。因此，我们的结果表明，旨在降低术前焦虑的干预措施将改善术后恢复过程。在过去的几年里，我们的实验室已经开发并验证了许多这样的干预措施。因此，在下一阶段的研究中，我们建议进行一项随机对照试验，考察各种术前干预措施对术后行为和临床恢复过程的影响。这将通过融合的临床、神经内分泌和行为测量进行评估。作为次要目标，我们将(1)评估儿童各种类型的术前干预措施对上述假设的影响，以及(2)检查这些术前干预措施在不同年龄段之间的有效性和一致性。这项研究的长期目标是评估、发展和实施将改善术后行为和临床恢复过程的术前干预措施。

DESCRIPTION (provided by applicant): This competing continuation seeks to extend an ongoing longitudinal project (R01HD37007-01) examining the relations between preoperative anxiety and postoperative behavioral and clinical recovery in a population of children undergoing surgery. Over five million children undergo surgery in the United States. It is estimated that up to 75 percent of these children develop extreme anxiety prior to their surgery. In adults, extreme preoperative anxiety has been shown to correlate with postoperative clinical outcomes such as pain and analgesic requirements, and prolonged recovery and hospital stay. In children, excluding data from our initial application, there are no peer reviewed, published outcome data regarding the question of whether heightened preoperative behavioral stress and anxiety impairs postoperative recovery. This issue is of extreme importance as several effective interventions are available to treat preoperative anxiety in children. Unfortunately, there is currently a strong trend towards reduction in these preoperative interventions. This trend is most likely a result of the present medical-economic climate and the absence of outcome data in children documenting a link between preoperative anxiety and postoperative recovery. In our initial application, we have demonstrated that high levels of preoperative anxiety in children are associated with increased postoperative pain and impaired clinical and behavioral postoperative recovery. Thus, our results suggest that interventions aimed at the reduction of preoperative anxiety will improve the postoperative recovery process. Over the past several years our laboratory has developed and validated a number of such interventions. Thus, in the next phase of the study, we propose a randomized controlled trial that will examine the impact of various preoperative interventions on the postoperative behavioral and clinical recovery process. This will be assessed by convergent clinical, neuroendocrinological, and behavioral measures. As secondary aims we will (1) evaluate the impact of various types of preoperative interventions in children to the above hypothesis, and (2) examine the effectiveness and consistency of these preoperative interventions across various age groups. The broad, longterm objectives of this research are the evaluation, development and implementation of preoperative interventions that will improve the postoperative behavioral and clinical recovery process.