音频疗法对皮肤外科局麻手术患儿生命体征的影响(1)
[摘要]目的：探讨音频疗法对皮肤外科局麻手术患儿生命体征及手术配合度的影响。方法：将100例皮肤外科局麻手术患儿随机分为两组，每组50例。对照组患儿术中给予常规基础护理，实验组患儿在对照组基础上加入音频疗法，以接诊当日血压、心率为基础，比较手术当天术前(拍照时)、术中(局麻开始后5min内)、术后(手术结束后10min)两组患儿的生命体征变化(血压、心率)、疼痛评分变化(以FLACC法评估)。结果：实验组术中、术后FLACC评分均优于对照组，差异有统计学意义(P<0.01)。两组患儿术前血压和心率与基础值比较，并进行组间比较，差异均无统计学意义(P>0.01);术中及术后对照组血压及心率明显高于基础值，而实验组患儿术中及术后血压、心率虽有所升高，但与基础值无明显差异，且显著低于对照组数值，差异有统计学意义(P<0.01)。结论：将音频疗法应用于局麻手术患儿可以更好地缓解紧张情绪，减少患儿恐惧心理，提高手术配合度，获得较好的护理效果。
[关键词]音频疗法;皮肤外科;局部麻醉;儿童;生命体征
[中图分类号]R473.6 [文献标志码]B [文章编号]1008-6455(2019)11-0146-02
Abstract： Objective To explore the effect of music therapy on vital signs and operative coordination in children undergoing dermatologic surgery in local anesthesia. Methods 100 patients who underwent dermatologic surgery using local anesthesia were randomly divided into the experimental group (n=50) and the control group (n=50). The patients in the control group received regular care， while the patients in the experimental group received music therapy in addition to regular care. The changes of vital signs and postoperative FLACC scores of the two groups were observed at the day before surgery， preoperatively (at the time before entering the operating room)， intraoperatively (5 minutes after the beginning of local anesthesia) and postoperatively (10 minutes after the operation). Results The FLACC score of the experimental group was better than that of the control group during and after the operation， and the difference was statistically significant(P<0.01). Preoperative blood pressure， heart rate and baseline values were compared between the two groups. There was no significant difference between the two groups(P>0.01). The blood pressure and heart rate of the control group were significantly higher than the baseline values during and after the operation， while the blood pressure and heart rate of the experimental group increased， but there was no significant difference with the baseline values， and significantly lower than that of the control group(P<0.01). Conclusion The application of audio therapy in children with local anesthesia surgery can better relieve tension， reduce fear of children， improve the degree of operation cooperation， and obtain better nursing effect.
Key words： music therapy; skin surgery; local anesthesia; children; vital signs
隨着我国医疗卫生事业的发展及公众需求的不断增加，皮肤外科就诊患者逐渐增加，涉及的病种、术式、人群日益增多，幼儿患者作为特殊群体，其麻醉方式及配合度直接影响手术能否顺利进行。目前，对于3岁以内患儿，水合氯醛配合局麻药物的使用较为普遍;而对于3岁以上患儿，麻醉方式以局部麻醉为主，需要患儿主观配合。通过便携电子设备(手机或平板电脑)播放儿童歌曲或动画音频，属于音乐疗法的范畴，后者为医学、心理学及音乐的综合产物。研究报道，通过倾听音乐，可以有效降低身体应激，缓解紧张、焦虑情绪，并改善基本生命体征如心率、血压等，在患者清醒的有创治疗中可以起到很好效果[1-3]。皮肤外科手术绝大部分是门诊手术，以局部麻醉为主，很多患儿由于环境陌生、内心恐惧，对手术产生紧张、焦虑情绪，配合度较差。加之手术时没有父母陪伴，处于手术室隔离环境中，加重其惧怕心理，往往会导致哭闹、不配合、血压、心率升高，影响手术的顺利进行。本文拟通过对皮肤外科局麻手术患儿进行音乐干预，观察其对生命体征及疼痛影响，进而探讨其对心理状态的影响。, 百拇医药(范艳梅 许美凤 程传涛)
[关键词]音频疗法;皮肤外科;局部麻醉;儿童;生命体征
[中图分类号]R473.6 [文献标志码]B [文章编号]1008-6455(2019)11-0146-02
Abstract： Objective To explore the effect of music therapy on vital signs and operative coordination in children undergoing dermatologic surgery in local anesthesia. Methods 100 patients who underwent dermatologic surgery using local anesthesia were randomly divided into the experimental group (n=50) and the control group (n=50). The patients in the control group received regular care， while the patients in the experimental group received music therapy in addition to regular care. The changes of vital signs and postoperative FLACC scores of the two groups were observed at the day before surgery， preoperatively (at the time before entering the operating room)， intraoperatively (5 minutes after the beginning of local anesthesia) and postoperatively (10 minutes after the operation). Results The FLACC score of the experimental group was better than that of the control group during and after the operation， and the difference was statistically significant(P<0.01). Preoperative blood pressure， heart rate and baseline values were compared between the two groups. There was no significant difference between the two groups(P>0.01). The blood pressure and heart rate of the control group were significantly higher than the baseline values during and after the operation， while the blood pressure and heart rate of the experimental group increased， but there was no significant difference with the baseline values， and significantly lower than that of the control group(P<0.01). Conclusion The application of audio therapy in children with local anesthesia surgery can better relieve tension， reduce fear of children， improve the degree of operation cooperation， and obtain better nursing effect.
Key words： music therapy; skin surgery; local anesthesia; children; vital signs
隨着我国医疗卫生事业的发展及公众需求的不断增加，皮肤外科就诊患者逐渐增加，涉及的病种、术式、人群日益增多，幼儿患者作为特殊群体，其麻醉方式及配合度直接影响手术能否顺利进行。目前，对于3岁以内患儿，水合氯醛配合局麻药物的使用较为普遍;而对于3岁以上患儿，麻醉方式以局部麻醉为主，需要患儿主观配合。通过便携电子设备(手机或平板电脑)播放儿童歌曲或动画音频，属于音乐疗法的范畴，后者为医学、心理学及音乐的综合产物。研究报道，通过倾听音乐，可以有效降低身体应激，缓解紧张、焦虑情绪，并改善基本生命体征如心率、血压等，在患者清醒的有创治疗中可以起到很好效果[1-3]。皮肤外科手术绝大部分是门诊手术，以局部麻醉为主，很多患儿由于环境陌生、内心恐惧，对手术产生紧张、焦虑情绪，配合度较差。加之手术时没有父母陪伴，处于手术室隔离环境中，加重其惧怕心理，往往会导致哭闹、不配合、血压、心率升高，影响手术的顺利进行。本文拟通过对皮肤外科局麻手术患儿进行音乐干预，观察其对生命体征及疼痛影响，进而探讨其对心理状态的影响。, 百拇医药(范艳梅 许美凤 程传涛)