目的：构建基于循证的全麻苏醒期躁动（Emergence agitation，EA）预防方案，并评价其应用效果。方法：在最佳证据的基础上，通过小组讨论进行证据 FAME 属性的评价，针对 11 条证据进行临床应用并构建质量审查指标，于 2020 年 7 月 ~2021 年 2 月实施循证护理实践，通过基线审查（29 例患儿）分析障碍因素，构建全麻 EA 护理预防方案，并将此方案应用于 34 例患儿。结果：患儿 EA 发生率由 24.1% 降至 2.9%，显著低于证据应用前（P<0.05）。医护人员对预防全麻患儿 EA 的相关知识、态度与行为得分显著高于证据应用前 （P<0.05）。结论：基于循证构建的全麻 EA 护理预防方案可在机器人巨结肠手术中推广，且在实施中应结合临床情景考虑患儿个性化意愿，降低全麻患儿 EA 的发生率。

Objective: To construct an evidence-based prevention protocol of emergence agitation (EA) in children undergoing general anesthesia and evaluate its effect. Methods: The feasibility, appropriateness, meaningfulness and effectiveness of evidences were evaluated by group discussion. 11 items of evidence were clinically applied and quality review indicators were established. Evidence-based nursing practice was performed from July 2020 to February 2021. Clinical obstacles were identified by baseline review(29 children), and an evidence-based prevention protocol for EA with general anesthesia was constructed．Then the protocol was applied to another 34 children．Results: After application of the prevention protocol, the incidence of EA decreased from 24.1% to 2.9%, which was significantly lower than that before the application of evidence(P<0.05). The scores on knowledge, attitude and behavior of medical staff on EA were significantly higher than that before the application of evidence. Conclusion: The evidence-based prevention protocol of EA in children with Hirschsprung’s disease underwent robotic surgery could be popularized clinically. To decrease the incidence of EA, clinical settings and personalized patients’ willingness shall be considered during the implementation of the protocol.

收稿日期：2021-03-22  录用日期：2021-07-22

Received Date: 2021-03-22  Accepted Date: 2021-07-22

基金项目：湖北省自然科学基金科研项目（2019CFB725）

Foundation Item: Natural Science Foundation of Hubei Province(2019CFB725)

通讯作者：汤绍涛，Email：tshaotao83@126.com

Corresponding Author: TANG Shaotao, Email: tshaotao83@126.com

引用格式：史雯嘉，熊紫薇，黄燕，等 . 基于循证的全麻苏醒期躁动预防方案在机器人巨结肠手术中的应用实践 [J]. 机器人外科学杂志（中英文），2022，3（1）：33-41.

Citation: SHI W J, XIONG Z W, HUANG Y, et al. Application of evidence-based prevention protocol of emergence agitation in children with congenital megacoln under robotic surgery [J]. Chinese Journal of Robotic Surgery, 2022, 3(1): 33-41

[1] 汤绍涛 , 曹国庆 . 先天性巨结肠症的诊治现状 [J]. 临床小儿外科杂志 , 2012, 11(1): 62-65.

[2] Sikich N, Lerman J. Development and psychometric evaluation of the Pediatric anesthesia emergence delirium scale[J]. Anesthesiology, 2004, 100(5): 1138-1145.

[3] Rashidi A, Silverberg M L, Conkling P R, et al. Thrombosis in acute promyelocytic leukemia[J]. Thromb Res, 2013, 131(4): 281-289.

[4] 贾会英 , 梁靖 , 周梦 , 等 . 患儿全身麻醉苏醒期躁动及父母陪伴对其影响的研究进展 [J]. 中华护理杂志 , 2016, 51(10): 1230-1233. 

[5] Lucky A, Arie U, Elizeus H, et al. Incidence of emergence agitation in pediatric patient after general anesthesia[J]. Folia Medica Indonesiana, 2019, 55(1): 25-29.

[6] 历广招 , 杨夏 , 赵旭 , 等 . 预防全麻患儿苏醒期躁动的证据总结 [J]. 中国护理管理 , 2020, 20(7): 1049- 1054.

[7] 张鑫杰 . 改良耶鲁术前焦虑量表的汉化及信效度评价 [D]. 大连 : 大连医科大学 , 2018.

[8] TANG S T, WANG G B, CAO G Q, et al.10 years of experience with laparoscopic-assisted endorectal soave pull-through procedure for hirschsprung’s disease in China[J]. J Laparoendosc Adv Surg Tech A, 2012, 22(3): 280-284.

[9] 倪鑫 , 谭李红 , 舒强 , 等 . 精准医学与小儿外科 [J]. 临床小儿外科杂志 , 2017, 8(16): 315-318.

[10] 阳历 , 张茜 , 汤绍涛 . 手术机器人在小儿外科领域应用的机遇与挑战 [J]. 中华小儿外科杂志 , 2015, 36(10): 32-34.

[11] Hebra A, Smith V A, Lesher A P. Robotic Swenson pull-through for Hirschsprung’s disease in infants. Am Surg, 2011, 77(7): 937-41.

[12] 张茜 , 汤绍涛 , 曹国庆 , 等 .da Vinci 机器人辅助腹腔镜 Soave 拖出术治疗先天性巨结肠症 [J]. 中国微创外科杂志 , 2016, 16(2): 165-167.