Int J Stomatol

Int J Stomatol ›› 2023, Vol. 50 ›› Issue (3): 272-278.doi: 10.7518/gjkq.2023054

• Cleft Lip and Palate • Previous Articles     Next Articles

Construction of a multi-dimensional intervention system for emergence agitation in pediatric patients with cleft lip and/or palate

Wan Xueli1(),Shi Yongle2,Zhang Xiufen1,Wang Huan1,Tian Li1()   

  1. 1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Anesthesia and Resuscitation Room, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Emergency, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-10-12 Revised:2023-02-01 Online:2023-05-01 Published:2023-05-16
  • Contact: Li Tian E-mail:1139267496@qq.com;1768251676@qq.com

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Abstract:

Objective We constructed and applied a multi-dimensional intervention system under general anesthesia to reduce the incidence of emergence agitation (EA) in pediatric patients with cleft lip and/or palate. Methods Expert consultation was used to construct the intervention system. We conveniently selected 119 pediatric patients with cleft lip and/or palate from the Department of Oral and Maxillofacial Surgery, a university-affiliated tertiary hospital in Sichuan province, from November 2021 to June 2022. The patients were divided into an experimental group of 59 cases and a control group of 60 cases. The intervention system was applied to patients in the experimental group, while routine intervention was administered to patients in the control group. The effect of the intervention was assessed using the Pediatric A-nesthesia Emergence Delirium (PAED) scale and the Face, Legs, Activity, Crying, Consolability (FLACC) scale. Results The multi-dimensional intervention system for EA included 3 primary indicators, 6 secondary indicators, and 14 tertiary indicators. Patients in PACU and those leaving from post anesthesia care unit (PACU) in the experimental group had a lower incidence of EA than the control group (P<0.05), while no statistically significant differences in the incidence of postoperative vital signs, FLACC score, and complications were found between the two groups (P>0.05). Conclusion The proposed multi-dimensional intervention system can reduce the incidence of EA in pediatric patients with cleft lip and/or palate but has no definite improvement for the incidence of pain and postoperative complications.

Key words: multi-dimensional intervention, cleft lip and/or palate, emergence agitation, expert consultation

CLC Number: 

  • R 781.12

TrendMD: 

Fig 1

The multi-dimensional intervention system for EA in pediatric patients with cleft lip and/or palate"

Tab 1

Intervention methods of experimental group"

项目措施
环境维度①硬环境：房间布局合理、宽敞明亮、监护设备及抢救物资配备齐全；②软环境：建立童趣化病房，根据患儿各年龄段喜好准备相应物资，如视频、音箱、玩具、绘本、贴纸等
医护维度①研究前由组长从EA风险评估和EA干预2个方面对小组成员进行医护培训；②培训后采用问卷星形式对培训内容进行效果反馈，保证知晓率达100%
患者维度
术前健康宣教术前1 d采取医护一体化方式进行健康宣教，补充EA相关概念、临床表现、预防措施等，并了解患儿喜好
全麻苏醒前准备动态评估患儿麻醉结束时间，提前通知家属进入PACU内进行一对一陪护，结合特定健康宣教内容再次对家属进行EA相关知识宣教，根据患儿个性化需求，提供EA干预辅助工具
全麻苏醒期干预①常规监护患儿，评估患儿手术时间、麻醉时间、禁食时间等；②对患儿进行儿童麻醉苏醒期谵妄（pediatric anesthesia emergence delirium，PAED）量表评分和FLACC（Face，Legs，Activity，Crying，Consolability）疼痛评估量表评分，若PAED量表得分≥10分且/或FLACC疼痛评估量表得分>3分，通知麻醉值班医生进行干预；③做好EA相关预防及安全管理
出室准备行出室健康宣教及转运过程中的安全管理

Tab 2

The coefficient of concordance W of expert opinions"

指标W值Dfχ2 值P值
第1轮第2轮第1轮第2轮第1轮第2轮第1轮第2轮

一级

二级

三级

0.441

0.541

0.259

0.486

0.527

0.155

2

5

18

2

5

13

13.236

40.603

69.818

14.577

39.559

30.203

0.001

0.000

0.000

0.001

0.000

0.004

Tab 3

Data comparison of continuous variables"

项目对照组[M（P25，P75）]试验组[M（P25，P75）]Z值P值
年龄/岁13.18（4.00，14.75）9.00（6.00，13.00）0.5360.592
体重/kg9.00（7.30，10.45）9.00（8.00，10.00）0.3390.734
手术时间/min87.50（71.25，106.50）81.00（70.00，95.00）1.2480.212
麻醉时间/min125.00（106.25，140.00）115.00（100.00，135.00）1.6880.091
禁食时间/min432.50（385.00，585.00）420.00（350.00，540.00）1.0710.284

Tab 4

Data comparison of classification variables"

项目分类对照组（n/%）试验组（n/%）χ2 值P值
性别男30（50.00）27（45.76）0.2140.644
女30（50.00）32（54.24）
术前诊断唇裂29（48.33）21（35.59）1.9820.159
腭裂31（51.67）38（64.41）
手术序次1次53（88.33）49（83.05）0.6780.410
2次7（11.67）10（16.95）
ASA分级<3级16（26.67）22（37.27）1.5440.214
≥3级44（73.33）37（62.71）
敷料无36（60.00）45（76.66）3.6230.057
有24（40.00）14（23.73）
舌线无50（83.33）47（79.66）0.2660.606
有10（16.67）12（20.34）
碘仿无54（90.00）53（89.83）0.0010.976
有6（10.00）6（10.17）
鼻成型管无51（85.00）51（86.44）0.0500.822
有9（15.00）8（13.56）
主要照护者非父母19（31.67）11（18.64）2.6760.102
父母41（68.33）48（81.36）
照护者学历小学及以下11（18.33）9（15.25）6.2200.183
初中22（36.67）11（18.64）
高中/中专12（20.00）16（27.12）
大专7（11.67）12（20.34）
本科及以上8（13.33）11（18.64）

Tab 5

Comparison of postoperative vital signs"

项目对照组[M（P25，P75）]试验组[M（P25，P75）]Z值P值
入室血氧饱和度/%98（96.00，99.00）98（96.00，99.00）0.2010.841
PACU内血氧饱和度/%99（96.25，99.75）98（97.00，100.00）0.2490.803
出室血氧饱和度/%98（97.00，99.00）98（97.00，100.00）0.3820.703
入室心率/次·min-1148（136.00，168.00）143（132.00，162.00）1.4830.138
PACU内心率/次·min-1145（128.25，158.00）138（130.00，161.00）0.4650.642
出室心率/次·min-1142.5（130.00，153.75）136（122.00，150.00）1.4360.151

Tab 6

Comparison of EA, FLACC scores and com-plications"

项目对照组（n/%）试验组（n/%）χ2 值P值
入室躁动
是43（71.67）41（69.49）0.0680.795
否17（28.33）18（30.51）
PACU内躁动
是35（58.33）14（23.73）14.7070.000
否25（41.67）45（76.27）
出室躁动
是21（35.00）7（11.86）8.8490.003
否39（65.00）52（88.14）
FLACC疼痛评分
≤3分38（63.33）42（71.19）0.8330.361
>3分22（36.67）17（28.81）
并发症发生
是6（10.00）7（11.86）0.1060.774
否54（90.00）52（88.14）
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[1] Song Lei, Jiang Shuyuan, Jia Zhonglin, Shi Bing, Gong Caixia, Li Yang. Preliminary analysis on correlations between the symptoms related to upper respiratory infection and vital signs after operation of infants with cleft lip and/or palate [J]. Inter J Stomatol, 2017, 44(4): 398-404.
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