背景:借助先进的虚拟现实(VR)技术,它在医疗保健中的使用正在对患者的预后产生影响。接受膝关节置换手术的患者已经因为手术而感到焦虑,麻醉,和不熟悉的手术室环境。除此之外,工具发出的不愉快的噪音使情况变得更糟。围手术期焦虑与麻醉需求增加和恢复时间延长相关。它会导致皮质醇等压力荷尔蒙的释放,肾上腺素,去甲肾上腺素,由于血管收缩和心血管反应增强,这可能导致血管内通路困难。关于音乐疗法的研究表明皮质醇水平降低,有助于缓解焦虑。VR眼镜创造了身临其境的环境,以分散患者对各种压力因素的注意力。研究使用VR/music对膝关节置换手术中血清皮质醇和促肾上腺皮质激素(ACTH)水平的影响,可以改善围手术期护理,改善患者预后。
目的:探讨虚拟现实眼镜和音乐疗法对腰硬联合麻醉下膝关节置换术患者血清皮质醇和ACTH水平的影响。
方法:在这个前瞻性随机对照中,单中心研究,任何性别的患者,年龄在18至65岁之间,在腰硬联合(CSE)麻醉下进行膝关节置换手术,包括在内。主要目的是比较血清皮质醇和ACTH水平,次要目标是比较围手术期的状态-特质焦虑量表(STAI-SA)评分和患者满意度评分(PSS)。总共对100名患者进行了资格评估,66例患者符合纳入和排除标准,最终被随机分组,并平均分为M-VR组(音乐-虚拟现实)和C组(对照).术前1小时(T1)采集三份血样测定血清皮质醇和血清ACTH水平,皮肤切口后一小时(T2),以及手术完成后两小时(T3)。术前1小时(T1)和手术完成后2小时(T2)测量STAI-SA,而PSS记录在手术完成后两小时。在整个围手术期记录血流动力学参数。
结果:两组的人口统计学和人体测量参数具有可比性。血流动力学参数(心率[HR],平均动脉压[MAP])在术前阶段具有可比性,而在手术30分钟后发现显着差异(p>0.05),并持续到手术结束。术前血清皮质醇和血清ACTH水平相当,但在术中与C组相比,M-VR组的变化明显较低。与C组相比,M-VR组的PSS明显更高。
结论:这项研究证实了虚拟现实和音乐疗法(VR/音乐)在减轻焦虑方面的作用,满意度得分提高,膝关节置换手术中ACTH/皮质醇水平变化较小。它进一步强调了各种其他手术人群中更大的随机对照研究,以及长期随访和结果评估。
BACKGROUND: With advanced virtual reality (VR) technology, its usage in health care is creating an impact on patient outcomes. Patients undergoing knee replacement surgery are already anxious due to the surgery, anaesthesia, and unfamiliar environment of the operation theatre. In addition to that, the unpleasant noise of tools makes it worse. Peri-operative anxiety correlates with increased anaesthesia requirements and prolonged recovery. It causes the release of stress hormones such as cortisol, adrenaline, and norepinephrine, which can lead to difficult intravascular access due to vasoconstriction and heightened cardiovascular responses. Studies on music therapy have shown a reduction in cortisol levels, contributing to anxiety alleviation. VR glasses create immersive environments to distract patients from various stress factors. Investigating the use of VR/music on serum cortisol and adrenocorticotropic hormone (ACTH) levels in knee replacement surgery can improve peri-operative care, improving patient outcomes.
OBJECTIVE: The study was done to investigate the impact of virtual reality glasses and music therapy on serum cortisol and ACTH levels in patients undergoing knee replacement surgery under combined spinal epidural anaesthesia.
METHODS: In this prospective randomised control, single-centric study, patients of either sex, aged between 18 and 65 years, undergoing knee replacement surgery under combined spinal and epidural (CSE) anaesthesia, were included. The primary objective was to compare serum cortisol and ACTH levels, while the secondary objective was to compare the State-Trait Anxiety Inventory for State Anxiety (STAI-SA) score and Patient Satisfaction Score (PSS) in the peri-operative period. A total of 100 patients were assessed for eligibility, and 66 patients met the inclusion and exclusion criteria and were finally randomised and equally assigned to group M-VR (music-virtual reality) and group C (control). Three blood samples were collected for serum cortisol and serum ACTH levels one hour before surgery (T1), one hour after skin incision (T2), and two hours after the completion of surgery (T3). STAI-SA was measured one hour before surgery (T1) and two hours after the completion of surgery (T2), while PSS was recorded two hours after the completion of surgery. Hemodynamic parameters were noted during the entire peri-operative period.
RESULTS: The demographic and anthropometric parameters were comparable in both groups. Hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP]) were found to be comparable in the pre-operative period, while significant differences (p > 0.05) were noted after 30 minutes of surgery and continued till the end of surgery. Serum cortisol and serum ACTH levels were comparable in the pre-operative period but showed significantly lower variations in group M-VR in comparison to group C in the intra-operative period. PSS was significantly higher in group M-VR in comparison to group C.
CONCLUSIONS: This study substantiates the role of virtual reality and music therapy (VR/music) on anxiety reduction, improved satisfaction scores, and lesser ACTH/cortisol level variations in knee replacement surgery. It further emphasises larger randomised controlled studies in various other surgical populations, along with long-term follow-up and outcome assessment.