视频引导的术前模拟训练对儿童术后负性行为改变的影响：一项随机对照试验

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中文摘要

背景： 术后负性行为改变（NPOBCs）是儿童常见的术后并发症，若不加以处理，可能影响儿童的情绪和认知发育。本研究旨在探讨模拟训练能否降低接受扁桃体切除术和腺样体切除术的儿童术后负性行为改变的发生率。
方法： 在这项随机对照临床试验中，184例患者被随机分配（1:1，按年龄分层）至对照组或训练组。对照组仅接受术前访视，而训练组在术前访视后观看动画教学视频，并使用麻醉面罩和吸管进行模拟训练。在术后第3、14、28、90和180天使用住院后行为问卷对儿童进行评估，并根据住院后行为问卷评分>0诊断术后负性行为改变。主要结局是术后前28天内术后负性行为改变的累积发生率。次要结局包括诱导期焦虑、诱导期配合度、苏醒期谵妄和术后疼痛。
结果： 与对照组相比，训练组在手术后28天内术后负性行为改变的发生率显著较低（27.3% vs. 53.4%；比值比0.33；95%置信区间，0.18-0.61；P < 0.001）。训练组的诱导前焦虑评分较低（31.7 [26.7, 36.7] vs. 33.3[26.7, 46.6]；P = 0.037），诱导期配合度较高（23.9% vs. 9.1%；P = 0.008），苏醒期谵妄发生率较低（17.0% vs. 37.5%；P = 0.002）。中介效应分析显示，该干预可能通过减轻焦虑来降低术后负性行为改变的发生率。
结论： 术前模拟训练降低了接受扁桃体切除术和腺样体切除术的儿童短期术后负性行为改变的发生率，并改善了围手术期心理结局，提示这是一种可行的非药物策略，可增强儿科围手术期护理。
临床试验注册及编号： ChiCTR2400083163。

英文摘要

BACKGROUND: Negative postoperative behavioral changes (NPOBCs) are common postoperative complications in children and can affect children's emotional and cognitive development if not addressed. This study aimed to investigate whether simulation training could reduce the incidence of negative postoperative behavioral changes in children undergoing tonsillectomy and adenoidectomy.
METHODS: In this randomized controlled clinical trial, 184 patients were randomly assigned (1:1, stratified by age) to either the control or training group. The control group received only a preoperative visit, while the training group viewed an animated instructional video and underwent simulation training using an anesthetic mask and straw following the preoperative visit. Children were evaluated using the Post-Hospitalization Behavior Questionnaire on postoperative days 3, 14, 28, 90, and 180, and negative postoperative behavioral changes were diagnosed based on a Post-Hospitalization Behavior Questionnaire score >0. The primary outcome was the cumulative incidence of negative postoperative behavioral changes during the first 28 postoperative days. Secondary outcomes included induction anxiety, induction compliance, emergence delirium, and postoperative pain.
RESULTS: Compared with the control group, the training group had a significantly lower incidence of negative postoperative behavioral changes within 28 days of surgery (27.3% vs. 53.4%; odds ratio 0.33; 95% confidence interval, 0.18-0.61; P < 0.001). The training group had lower preinduction anxiety scores (31.7 [26.7, 36.7] vs. 33.3[26.7, 46.6]); P = 0.037), higher induction compliance (23.9% vs. 9.1%; P = 0.008), and a lower incidence of emergence delirium (17.0% vs. 37.5%; P = 0.002). Mediation effect analysis revealed that the intervention may reduce the incidence of negative postoperative behavioral changes by alleviating anxiety.
CONCLUSIONS: Preoperative simulation training reduced the incidence of short-term negative postoperative behavioral changes and improved perioperative psychological outcomes in children who underwent tonsillectomy and adenoidectomy, suggesting a feasible nonpharmacological strategy to enhance pediatric perioperative care.
CLINICAL TRIAL REGISTRY AND NUMBER: ChiCTR2400083163.