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| 多模式非药物干预对孤独症谱系障碍患儿麻醉诱导配合度的影响 |
| Effect of multimodal non-pharmacological intervention on anesthesia induction compliance in children with autism spectrum disorder |
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| DOI：10.12089/jca.2026.08.010 |
| 中文关键词: 多模式非药物干预 孤独症谱系障碍 儿童 麻醉诱导 配合度 |
| 英文关键词: Multimodal non-pharmacological intervention Autism spectrum disorder Child Anesthesia induction Compliance |
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| 中文摘要: |
目的： 评价一项整合了父母陪伴、玩具与视频并允许自主选择的多模式非药物干预方案，对改善孤独症谱系障碍（ASD）患儿麻醉诱导配合度的效果。
方法： 选择2025年1—4月初次行结肠途径经内镜肠道植管术（TET）的孤独症谱系障碍患儿，年龄2～8岁，ASA Ⅱ或Ⅲ级。采用随机数字表法将患儿分为两组：多模式非药物干预组（F组）和对照组（Ｃ组）。F组采用多模式非药物处理，患儿自主选择一种或多种方式，包括父母陪伴、携带喜爱的玩具、观看喜爱的视频节目入手术间进行麻醉诱导，麻醉诱导完成后父母离开内镜手术间；Ｃ组医务人员从等候区将患儿接入内镜手术间，入室后接受麻醉团队的标准安抚（语言安慰、快速诱导）。主要指标为诱导合作量表（ICC）评分≥4分的比例。次要指标包括可合作率（ICC评分0～3分），在术前等待区、进入内镜手术间后、麻醉诱导前即刻改良耶鲁术前焦虑量表（mYPAS）评分，获得首个生命体征时间（患儿从进入手术间至监护仪上首次稳定显示HR、BP、SpO2中任意一项的时间间隔），苏醒期术后躁动发生率，手术时间和丙泊酚用量。不良反应为术后24 h内恶心呕吐。
结果： 共纳入患儿60例，每组30例。与在术前等待区时比较，麻醉诱导前即刻C组mYPAS评分明显升高（P<0.05）。与C组比较，F组ICC评分明显降低，可合作率明显升高，进入内镜手术间后、麻醉诱导前即刻mYPAS评分明显降低，获得首个生命体征时间明显缩短（P＜0.05）。两组术后躁动发生率及丙泊酚用量差异无统计学意义。
结论： 对于接受内镜治疗的ASD患儿，实施以患儿自主选择为基础的多模式非药物干预，能安全、有效地提高其麻醉诱导配合度，显著缓解术前焦虑，并缩短无生命体征监测的时间。 |
| 英文摘要: |
Objective: To evaluate the effectiveness of a multimodal non-pharmacological intervention integrating parental presence, toys, and videos with autonomous choice, in improving anesthesia induction compliance in children with autism spectrum disorder (ASD).
Methods: Pediatric patients with ASD, aged 2-8 years, ASA physical status Ⅱ or Ⅲ, scheduled for their first colonoscopic transendoscopic enteral tubing (TET) from January 2025 to April 2025 were enrolled. They were randomly allocated using a random number table into two groups: the multimodal non-pharmacological intervention group (group F) and the control group (group C). In group F, pediatric patients autonomously selected one or more comforting methods (parental presence, bringing favorite toys, or watching favorite videos) to accompany them into the operating room for anesthesia induction, parents left after induction was completed. In group C, medical staff escorted the pediatric patients from the waiting area to the operating room, where they received standard comfort from the anesthesia team (verbal reassurance, rapid induction). The primary outcome was the proportion of children with an induction compliance checklist (ICC) score ≥ 4. Secondary outcomes included the cooperation rate (ICC score 0-3), modified Yale preoperative anxiety scale (mYPAS) scores at three time points (in the preoperative waiting area, upon entering the operating room, and immediately before anesthesia induction), the time to first vital sign recording (defined as the interval from entering the operating room to the first stable display of any one of HR, BP, or SpO2 on the monitor), incidence of emergence agitation, operation time, and propofol dosage. Adverse events were nausea and vomiting within 24 hours postoperatively.
Results: Sixty pediatric patients were enrolled, 30 pediatric patients in each group. Compared with the preoperative waiting area, the mYPAS score immediately before anesthesia induction was significantly increased in group C (P < 0.05). Compared with group C, group F had a significantly lower ICC score, a significantly higher cooperation rate, significantly lower mYPAS scores upon entering the operating room and immediately before anesthesia induction, and a significantly shorter time to first vital sign recording (P < 0.05). There were no significant differences between the two groups in the incidence of emergence agitation or propofol dosage.
Conclusion: For children with ASD undergoing endoscopic procedures, implementing a choice-based multimodal non-pharmacological intervention can safely and effectively improve anesthesia induction compliance, significantly alleviate preoperative anxiety, and shorten the duration without vital sign monitoring, providing evidence-based support for clinical adoption. |
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