Abstract:

Objective　To explore the nursing effect of childlike care in children with appendicitis after operation, so as to provide reference for clinical optimization of nursing program. Methods　This study was a randomized controlled trial. A total of 91 children with appendicitis admitted to Henan Children's Hospital from January 2020 to January 2023 were prospectively selected as the research objects and were divided into an observation group and a control group by the random number table method. In the control group, 15 boys and 30 girls, aged (8.56±2.06) years, received routine nursing. In the observation group, 18 boys and 28 girls, aged (9.15±2.22) years, were given childlike care based on the control group; both groups continued to be intervened until the children were discharged from hospital. The clinical indicators (exhaust time, bowel sound recovery time, defecation time, and hospitalization time), emergence agitation and postoperative behavior changes, medical compliance, pain degrees 2 h, 6 h, and 24 h after operation, and incidence of complications were compared between the two groups. χ² test, rank sum test, t test, and Mann-Whitney U test were used. Results　The exhaust time, bowel sound recovery time, defecation time, and hospitalization time in the observation group were shorter than those in the control group [(26.61±3.51) h vs. (28.51±4.21) h, (20.35±5.18) h vs. (22.40±4.25) h, (48.52±3.46) h vs. (51.24±5.10) h, 5.00 (4.00, 6.00) d vs. 6.00 (5.00, 7.00) d], with statistically significant differences (t=2.343, P=0.021; t=2.064, P=0.042; t=2.984, P=0.004; Z=5.121, P<0.001). The Pediatric Anesthesia Emergence Delirium Scale (PAED) score and the incidence of postoperative behavioral changes in the observation group were 13.00 (12.00, 14.00) points and 47.83% (22/46), which were lower than those in the control group [14.00 (13.00, 16.00) points and 73.33% (33/45)], with statistically significant differences (Z=5.341, P<0.001; χ²=6.122, P=0.013). The medical compliance of the observation group was significantly better than that of the control group, with a statistically significant difference (Z=2.038, P=0.042). The pain scores of the observation group 2 h, 6 h, and 24 h after operation were 3.50 (3.00, 5.00) points, 3.00 (2.00, 4.00) points, and 2.00 (1.00, 3.00) points, those of the control group were 5.00 (4.00, 5.00) points, 3.00 (3.00, 4.00) points, and 3.00 (2.00, 4.00) points, and the intergroup, time point, and intergroup and time point interaction tests showed statistically significant differences (χ²=204.912, P<0.001; χ²=6.801, P=0.033; χ²=46.483, P<0.001). There was no statistically significant difference in the incidence of complications between the observation group and the control group [4.35% (2/46) vs. 8.89% (4/45), χ²=0.775, P=0.379]. Conclusion　The implementation of childlike care is helpful to improve the postoperative medical compliance in children with appendicitis, shorten the time of hospitalization and gastrointestinal function recovery, alleviate the restlessness in the recovery period, reduce the postoperative behavior changes, and reduce the pain in children.

Key words:

Appendicitis, Laparoscopy, Childlike care, Complications, Children

摘要：

目的　探讨童趣化护理在小儿阑尾炎术后的护理效果，以期为临床优化护理方案提供参考。方法　本研究为随机对照试验。前瞻性选取2020年1月至2023年1月河南省儿童医院收治的91例阑尾炎患儿作为研究对象，采用随机数字表法将其分为观察组与对照组，两组患儿均接受同一手术团队实施的腹腔镜阑尾切除术治疗。对照组45例中男15例，女30例，年龄（8.56±2.06）岁，采用常规护理；观察组46例中男18例，女28例，年龄（9.15±2.22）岁，在对照组基础上联合使用童趣化护理；两组均连续干预至患儿出院。比较两组患儿的临床指标（排气时间、肠鸣音恢复时间、排便时间、住院时间）、苏醒期躁动与术后行为改变情况、医护依从性、术后2 h、6 h、24 h的疼痛程度、并发症发生率。采用χ²检验、秩和检验、t检验、Mann-Whitney U检验。结果　观察组患儿的排气时间、肠鸣音恢复时间、排便时间以及住院时间均短于对照组［（26.61±3.51）h比（28.51±4.21）h、（20.35±5.18）h比（22.40±4.25）h、（48.52±3.46）h比（51.24±5.10）h、5.00（4.00，6.00）d比6.00（5.00，7.00）d］，差异均有统计学意义（t=2.343，P=0.021；t=2.064，P=0.042；t=2.984，P=0.004；Z=5.121，P<0.001）。观察组患儿的儿童麻醉苏醒期谵妄量表评分及术后第2天行为改变发生率分别为13.00（12.00，14.00）分、47.83%（22/46），均低于对照组的14.00（13.00，16.00）分、73.33%（33/45），差异均有统计学意义（Z=5.341，P<0.001；χ²=6.122，P=0.013）。观察组患儿医护依从性高于对照组（Z=2.038，P=0.042）。术后2、6、24 h，观察组疼痛评分分别为3.50（3.00，5.00）分、3.00（2.00，4.00）分、2.00（1.00，3.00）分，对照组分别为5.00（4.00，5.00）分、3.00（3.00，4.00）分、3.00（2.00，4.00）分，两组患儿疼痛评分组间、时点、组间与时点交互检验显示，差异均有统计学意义（χ²=204.912，P<0.001；χ²=6.801，P=0.033；χ²=46.483，P<0.001）。观察组患儿并发症发生率与对照组比较差异无统计学意义［4.35%（2/46）比8.89%（4/45），χ²=0.775，P=0.379］。结论　实施童趣化护理有助于提高阑尾炎患儿的术后医护依从性，缩短胃肠功能恢复时间和住院时间，减轻苏醒期躁动程度，减少术后行为改变，缓解疼痛。

关键词:

阑尾炎, 腹腔镜, 童趣化护理, 并发症, 儿童