择期手术患儿术前禁食禁饮时间过长原因分析及对策

目的规范择期手术患儿术前禁食、禁饮的时间和方法。方法采用面对面访谈的方法，按照自行设计的调查表，询问200例择期手术患儿家长患儿实际禁食禁饮的起止时间；患儿是否出现禁食禁饮所致的不良反应，如口渴、饥饿、哭闹、脱水等，家长的焦虑程度。结果医嘱要求患儿术前禁食4～8h，禁饮4h。择期手术患儿术前实际禁食、禁饮的时间普遍过长，〈6个月患儿平均禁食8．11h、禁饮8．02h；～12个月的患儿平均禁食9．81h、禁饮9．38h；～3岁患儿平均禁食10．98h、禁饮10．21h；～7岁患儿平均禁食15．12h、禁饮14．12h。〈6个月的婴儿及新生儿均出现口渴、饥饿、哭闹等不良反应，6例有轻度脱水表现；～12个月患儿有64．0％出现口渴、饥饿、哭闹等不良反应，2例有轻度脱水表现；～3岁患儿有44．0％出现哭闹，60．0％诉饥饿口渴，2例有轻度脱水表现；～7岁患儿有12．0％出现哭闹，36．0％诉口渴，48．0％诉饥饿，没有患儿出现脱水表现。对家长的焦虑评价中，45．0％的家长〉4分。结论目前择期手术患儿术前禁食禁饮时间过长。择期手术患儿术前禁食禁饮时间过长的原因与以下几方面有关：医护人员及患儿家长认识上存有误区；医护人员工作流程不规范，工作不够细致；对家属宣教欠缺，家长配合欠佳。为避免择期手术患儿术前禁食禁饮时间过长造成患儿不适及出现不良反应，需要医护人员更新观念，规范工作流程，加强宣教，加强医患合作。

Causes of Prolonged Duration of Fasting and Water-deprivation of Children Undergoing Elective Operation and the Care Strategy

Objective To regulate proper duration and methods of fasting and water-deprivation of children undergoing elective operation. Methods Parents of 200 child patients undergoing elective operation were interviewed about the duration of fasting and water-deprivation, the adverse reaction like thirst, hunger, crying, dehydration and parents＇ anxiety degree by using face-to-face interviewing and self-designed questionnaire. Results Doctor＇s advice asked child patients to have 4～8 hours＇ duration of fasting and water-deprivation. The real duration of fasting and water-deprivation of child patients undergoing elective operation was long. Many infant and child patients with different ages had adverse reaction like thirst, hunger and crying. 6 cases were even found to have slight dehydration. Scores of 45.0% parents of child patients were over 4 in anxiety evaluation. Conclusion The current duration of fasting and water-deprivation is too long. The reasons causing that are wrong cognition of doctors, nurses and patient＇s parents, inadequate standardized procedure, careless work, poor health education for patient＇s parents and their incoordination. In order to avoid the adverse reaction and uncomfortableness of child patients undergoing elective operation, it is necessary to renew medical staff＇s conception, standardize working procedure, enhance health education and improve cooperation between nurses and patients.