昼夜变化对儿童全身麻醉和手术后出现谵妄的影响。

IF 2.1 3区 医学 Q2 PEDIATRICS
Frontiers in Pediatrics Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1437460
Wei Wei, Haihang Xie, Yingyi Xu, Jingwen Qin, Xinying Guo, Xingrong Song, Gaofeng Yu, Na Zhang, Daqing Ma, Yonghong Tan, Tianyun Zhao
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引用次数: 0

摘要

背景:谵妄(ED)是一个公认的问题,它会延长机械通气和麻醉后护理病房(PACU)的复苏时间,从而增加医院成本和死亡率。术后昼夜节律紊乱通常会导致睡眠失调,已被确定为引发急诊谵妄的重要风险因素。然而,手术时间(上午与下午)对接受全身麻醉的儿科患者 ED 发生率的影响仍然未知:方法:根据麻醉开始时间,将双频谱指数值在 50-60 之间的 2-6 岁全身麻醉手术患者分为上午手术组(M 组,8:00-12:00)或下午手术组(A 组,13:00-17:00)。主要结果是根据康奈尔儿童谵妄评估(CAPD)评分评估拔管后ED发生率。次要结果包括拔管时间、PACU停留时间以及术后不良事件和并发症:与 M 组相比,A 组的 ED 发生率明显更高(P P P P 结论:我们的研究强调了手术时间的重要性:我们的研究表明,手术时间对儿童 ED 发生率、CAPD 评分和 PACU 留观时间有重大影响。对这些发现的进一步验证可指导未来减少 ED 的策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The impact of diurnal variations on emergence delirium following general anesthesia and surgery in children.

Background: Emergence delirium (ED) is a widely recognized issue that prolongs mechanical ventilation and post-anesthesia care unit (PACU) resuscitation time, consequently increasing hospital costs and mortality. Postoperative disturbance in circadian rhythms, commonly leading to sleep disorders, has been identified as a significant risk factor for ED. However, the influence of surgery timing (morning vs. afternoon) on the incidence of ED in pediatric patients undergoing general anesthesia remains unknown.

Methods: Patients aged 2-6 years who were operated on under general anesthesia with a bispectral index value between 50 and 60 were categorized based on anesthesia start time into either the morning surgery group (Group M, 8:00-12:00) or the afternoon surgery group (Group A, 13:00-17:00). The primary outcome was the post-extubation incidence of ED assessed by the Cornell Assessment of Pediatric Delirium (CAPD) score. Secondary outcomes included extubation time, duration of PACU stay, and adverse postoperative events and complications.

Results: We recruited a total of 560 patients, 280 in group M and 280 in group A. Compared to Group M, Group A exhibited a significantly higher incidence of ED (p < 0.001), elevated CAPD scores (p < 0.001), and prolonged PACU stays (p < 0.001). Notably, there was no significant difference in extubation time and anesthesia-related adverse events or other postoperative complications between the groups.

Conclusion: Our study highlights that the time of surgery significantly affects the incidence of ED, CAPD scores, and PACU stay duration in children. Further validation of these findings may guide future strategies to reduce ED.

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来源期刊
Frontiers in Pediatrics
Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.60
自引率
7.70%
发文量
2132
审稿时长
14 weeks
期刊介绍: Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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