摘要
目的探讨不同麻醉方式对咽部手术患儿近期医疗恐惧程度及对其远期身心健康的影响,为选择合理的麻醉方式提供依据。方法选择行咽部手术采用局麻和全麻的患儿各48例,应用儿童医疗恐惧量表（CMFS）调查手术前后恐惧程度;选择行全麻和局麻咽部手术术后3~5年的儿童各50例,参照蒙特梭利儿童观中儿童恐惧症状及身心健康的表现,自行设计心理状况问卷调查表进行相关的身心健康调查。结果住院局麻组患儿术后恐惧评分（除注射、呕吐2项外）显著高于全麻组患儿（P〈0.05,P〈0.01）;出院局麻组患儿的恐惧症状及对生活学习的影响显著高于全麻组患儿（P〈0.05,P〈0.01）。结论局麻方式对咽部手术患儿造成的恐惧较高,对患儿生活学习甚至择业均造成一定程度的影响。医务人员应告知家长两种麻醉方式的优缺点,根据具体情况合理选择麻醉方式,以最大限度降低患儿的恐惧感,提高其手术后的生活质量。
Objective To investigate the degree of children′s sensation of medical phobia during pharyngeal and laryngeal surgery under different anesthesia methods,to explore the long term effect of medical phobia,and to provide information for selection of appropriate anesthesia methods.Methods Forty-eight children who received pharyngeal and laryngeal surgery under general anesthesia,and 48 received the same surgery under local anesthesia were extracted at random.The selected children were investigated by using the Child Medical Fear Scale（CMFS）.Fifty children who had received pharyngeal and laryngeal surgery under general anesthesia 3-5 years before,and 50 who had received the same surgery under local anesthesia were extracted at random.According to children′s scare and of physical and mental health manifested in Montessori Child View,a psychological questionnaire was designed,which was used to observe children′s psychological health.Results Among hospitalized children,those receiving pharyngeal and laryngeal surgery under local anesthesia had significantly higher level of fear（except fear induced by injection and vomit）than those under general anesthesia（P0.05,P0.01）.Among discharged children,the degree of fear perceived by the children under local anesthesia was significantly stronger than that perceived by those under general anesthesia;the fear exerted more severe impact on the further life and study of the children under local anesthesia than those under general anesthesia（P0.05,P0.01）.Conclusion Surgery conducted under local anesthesia caused children′s fearful nightmare which had certain impact on their life.Medical staff should fully inform the parents of the advantage and disadvantage of two anesthesia ways so that they can make an appropriate choice to minimize the degree of fear perceived by the children and to improve their post-operative quality of life.
基金
华中科技大学同济医学院附属协和医院课题(2007-58)
关键词
儿童
咽部手术
全身麻醉
局部麻醉
医疗恐惧
身心健康
数据收集
children
pharyngeal and laryngeal surgery
general anesthesia
local anesthesia
medical phobia
physical and mental health
data collection
