Objective: To investigate the effectiveness of child-centered playful companionship and sedative medication in alleviating preoperative anxiety in preschool children. Methods: A retrospective analysis was conducted on 3 825 preschool children (3-6 years) who underwent elective surgery at Shanghai Children's Medical Center from April 2021 to March 2022. The children were divided into three groups based on the preoperative anxiolytic intervention: child-centered playful companionship group (n=2 198), pharmacological sedation group (n=1 281), and no intervention group (n=346). The pharmacological sedation group received intranasal dexmedetomidine at 2 μg/kg or oral midazolam syrup at 0.5 mg/kg. The child-centered playful companionship group received care from certified preoperative sedation nurses using a child-centered playful nursing model. The no intervention group did not receive any anti-anxiety measures due to various subjective and objective reasons. Preoperative separation anxiety scores (PSAS), sedation medication usage, and Ramsay sedation scores were recorded for all children. The primary outcome was the success rate of separation based on PSAS scores across different anxiolytic intervention groups, while the secondary outcome was the Ramsay sedation score. Results: The child-centered playful companionship group included 1 462 boys and 736 girls, with a median age [M (Q1, Q3)]of 59 (49, 69) months. The pharmacological sedation group included 824 boys and 457 girls, with a median age of 52 (42, 61) months; and the no intervention group included 212 boys and 134 girls, with a median age of 57 (48, 69) months. The success rate of separation in the child-centered playful companionship group was 95.6% (2 102/2 198), and in the pharmacological sedation group was 93.8% (1 202/1 281), both significantly higher than the 43.6% (151/346) of the no intervention group (all P<0.05). Among the 1 281 children in the pharmacological sedation group, 785 received oral midazolam and 496 received intranasal dexmedetomidine. Compared to the intranasal dexmedetomidine group, the oral midazolam group was younger, had a lower body weight and a higher proportion of American Society of Anesthesiologists (ASA) class Ⅲ (all P<0.05). The success rate of separation was 93.4% (733/785) in the oral midazolam group and 94.6% (469/496) in the intranasal dexmedetomidine group, with no statistically significant difference (P=0.392). The Ramsay sedation score was 2 (2, 2) in the intranasal dexmedetomidine group, better than the 2 (2, 2) of the oral midazolam group (P=0.024). Conclusion: Both child-centered playful companionship and pharmacological sedation effectively alleviate preoperative anxiety in preschool children.
目的： 探讨童趣化陪伴和药物镇静两种方式对缓解学龄前患儿术前焦虑的有效性。 方法： 回顾性分析上海儿童医学中心2021年4月至2022年3月择期手术学龄前（3~6岁）患儿3 825例，根据术前抗焦虑方案分为3组：童趣化陪伴组（n=2 198）、镇静药物组（n=1 281）和未干预组（n=346）。镇静药物组给予右美托咪啶2 μg/kg滴鼻，或咪达唑仑糖浆0.5 mg/kg口服。童趣化陪伴组由获得认证的专职术前镇静护士提供童趣化护理模式。未干预组为由于各种主观及客观原因，未实施任何抗焦虑方案。记录所有患儿的术前分离焦虑评分（PSAS）、镇静用药情况和Ramsay镇静深度评分。主要观察指标为基于PSAS评分评估的不同抗焦虑方案组的分离成功率，次要观察指标为Ramsay镇静深度评分。 结果： 童趣化陪伴组男1 462例，女736例，年龄［M（Q1，Q3）］为59（49，69）个月；镇静药物组男824例，女457例，年龄为52（42，61）个月；未干预组男212例，女134例，年龄为57（48，69）个月。童趣化陪伴组分离成功率为95.6%（2 102/2 198），镇静药物组分离成功率为93.8%（1 202/1 281），均高于未干预组的43.6%（151/346）（均P<0.05）。使用镇静药物的1 281例患儿中，785例口服咪达唑仑，496例鼻内滴注右美托咪啶。与右美托咪啶滴鼻组比较，口服咪达唑仑组月龄较小、体重较轻、美国麻醉医师协会（ASA）分级Ⅲ级比例较高（均P<0.05）。口服咪达唑仑组分离成功率为93.4%（733/785），右美托咪啶滴鼻组为94.6%（469/496），差异无统计学意义（P=0.392）。右美托咪啶滴鼻组Ramsay镇静深度评分为2（2，2）分，优于口服咪达唑仑组的2（2，2）分（P=0.024）。 结论： 童趣化陪伴和药物镇静均可有效缓解学龄前患儿术前焦虑。.