视觉模拟量表（VAS-I）评估麻醉诱导期间患儿的焦虑：日间手术患者的结果支持其有效性
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A Visual Analog Scale to assess anxiety in children during anesthesia induction (VAS-I): Results supporting its validity in a sample of day care surgery patients
背景与目的
改进的耶鲁术前焦虑量表被广泛用于评估麻醉诱导过程中儿童的焦虑，但需要经过训练，且实施起来耗费时间。相比之下，视觉模拟量表不需要训练，容易使用并且很快完成。本研究的目的是评价视觉模拟量表作为一种工具来评估在麻醉诱导期间患儿的焦虑以及如何区分焦虑和不焦虑患儿的有效性。
方 法
纳入了401例（1.5-16岁）择期行日间手术的患儿。麻醉诱导过程患儿的焦虑情况分别由父母、麻醉医师通过视觉模拟量表以及一个训练有素的观察员通过改良耶鲁术前焦虑量表来评估。心理测量学特性评估有：（i）同时效度（父母、麻醉医师的视觉模拟评分及改良耶鲁术前焦虑量表得分之间的相关性）；（ii）结构效度（亚组间的差异根据孩子的年龄和父母的焦虑用状态-特质焦虑量表评定）；（iii）使用布兰德-奥特曼分析跨线人协议；（iv）区分焦虑和不焦虑患儿之间的分割点（参考：改良耶鲁术前焦虑量表评分≥30）。
结 果
父母、麻醉医师的视觉模拟评分及改良耶鲁术前焦虑评分之间的相关性强（分别为0.68和0.73）。和大于6岁的患儿相比，小于5岁的患儿视觉模拟量表得分较高。高焦虑父母的患儿视觉模拟量表得分高于低焦虑父母的患儿。父母和麻醉医生的视觉模拟评分的平均差为3.6，95%可信区间为（56.1至63.3）。父母、麻醉医生视觉模拟评分分别≥37mm和≥30mm可确定患儿处于焦虑状态。
结 论
本研究提供了视觉模拟量表评价麻醉诱导期间患儿焦虑有效性的初步数据。
原始文献摘要
Johan M. Berghmans，Marten J. Poley; A Visual Analog Scale to assess anxiety in children during anesthesia induction (VAS-I): Results supporting its validity in a sample of day care surgery patients ;Anesth Analg. 2017 Jul 14. doi: 10.1111/pan.13206.
Background: The modified Yale Preoperative Anxiety Scale is widely used to assess children’s anxiety during induction of anesthesia, but requires training and its admin- istration is time-consuming. A Visual Analog Scale, in contrast, requires no training, is easy-to-use and quickly completed. Aim: The aim of this study was to evaluate a Visual Analog Scale as a tool to assess anxiety during induction of anesthesia and to determine cut-offs to distinguish between anxious and nonanxious children.
Methods: Four hundred and one children (1.5-16 years) scheduled for daytime surgery were included. Children’s anxiety during induction was rated by parents and anesthesiologists on a Visual Analog Scale and by a trained observer on the modified Yale Preoperative Anxiety Scale. Psychometric properties assessed were: (i) concurrent validity (correlations between parents’ and anesthesiologists’ Visual Analog Scale and modified Yale Preoperative Anxiety Scale scores); (ii) construct validity (differences between subgroups according to the children’s age and the parents’ anxiety as assessed by the State-Trait Anxiety Inventory); (iii) cross-infor- mant agreement using Bland-Altman analysis; (iv) cut-offs to distinguish between anxious and nonanxious children (reference: modified Yale Preoperative Anxiety Scale ≥30).
Results: Correlations between parents’ and anesthesiologists’ Visual Analog Scale and modified Yale Preoperative Anxiety Scale scores were strong (0.68 and 0.73, respectively). Visual Analog Scale scores were higher for children ≤5 years compared to children aged ≥6. Visual Analog Scale scores of children of high-anxious parents were higher than those of low-anxious parents. The mean difference between parents’ and anesthesiologists’ Visual Analog Scale scores was 3.6, with 95% limits of agreement (_56.1 to 63.3). To classify anx- ious children, cut-offs for parents (≥37 mm) and anesthesiologists (≥30 mm) were established.
Conclusions: The present data provide preliminary data for the validity of a Visual Analog Scale to assess children’s anxiety during induction.
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