目的:很少有研究关注虚拟现实(VR)暴露对接受妇科手术的成年女性患者术后急性疼痛的影响。
方法:随机对照试验(RCT)研究。
方法:北京复兴医院.
方法:115名年龄在20至60岁之间的患者,连续纳入美国麻醉医师协会(ASA)体质I-II,随机分为VR组(n=58)和对照组(n=57)。
方法:VR组患者在手术前接受15分钟的VR视频观看。
方法:主要结果是8小时的急性术后疼痛,通过视觉模拟评分(VAS)评分进行测量。次要结果包括使用镇痛药物,术后24h记录中度疼痛发生率及术后恢复情况。医院焦虑和抑郁量表(HADS)也用于评估患者手术前的情绪状态。
结果:30分钟时的VAS评分[2(1,2)与3(2,3)],2h[2(2,3)vs.4(3,4)],4h[3(2,4)vs.4(4,5)],8h[3(2,4)vs.4(4,5)],12h[2(2,3)vs.4(3,4)],24h[1(1,2)vs.3(2,3)]术后。广义估计方程(GEE)表明,VR干预与术后VAS值呈负相关(β=-0.830,S.E=0.199,95CI(-1.220,-0.439),Waldχ2=17.359,p<0.05),与此同时,VR还可降低术后8小时中度疼痛(VAS>4)的发生率(12.1%vs31.0%,p=0.013)。然而,24h曲马多用量保持不变。VR组患者睡眠质量较好(6.33±2.3vs.4.12±2.5,p<0.001)和更低的恶心发生率(43.1%vs.63.2%,p<0.05),头晕(0%vs.14.0%,p<0.05),和头痛(12.1%vs.29.8%,p<0.05)。VR可以降低术前HADS评分中位数(9.81±6.1vs3.14±3.9,p<0.001)和血压。
结论:VR干预能减轻妇科腹腔镜手术成年女性患者术后急性疼痛,术后恢复较好,术前焦虑水平较低。
OBJECTIVE: Few studies have focused on the effect of virtual reality (VR) exposure on postoperative acute pain in adult female patients undergoing gynecology surgery.
METHODS: A randomized control trial (RCT) study.
METHODS: At Beijing Fuxing Hospital.
METHODS: 115 patients aged between 20 and 60 years, American Society of Anesthesiologists (ASA) physical status I - II were consecutively enrolled and randomly divided into VR group (n = 58) or control group (n = 57).
METHODS: Patients in the VR group received 15 min of VR video viewing before surgery.
METHODS: The primary outcome was acute postoperative pain at 8 h which was measured by the Visual Analogue Scale (VAS) scores. The secondary outcomes including the use of analgesic drugs, the incidence of moderate pain and postoperative recovery which were recorded 24 h after surgery. The Hospital Anxiety and Depression Scale (HADS) was also used to evaluate patients\' emotional status before surgery.
RESULTS: The VAS scores at 30 min [2 (1,2) vs. 3 (2,3)], 2 h [2 (2,3) vs. 4 (3,4)], 4 h [3 (2,4) vs. 4 (4,5)], 8 h [3 (2,4) vs. 4 (4,5)], 12 h [2 (2,3) vs. 4 (3,4)], 24 h [1 (1,2) vs. 3 (2,3)] after surgery. Generalized estimation equation (GEE) indicated that VR intervention was negatively correlated with postoperative VAS values (β = -0.830, S.E = 0.199, 95%CI (-1.220,-0.439), Wald χ2 = 17.359, p<0.05), in the meanwhile, VR also lower the incidence of moderate pain (VAS > 4) at 8 h postoperatively (12.1% vs 31.0%, p = 0.013). However, the 24 h tramadol usage remained unchanged. Patients in the VR group had better sleep quality (6.33 ± 2.3 vs. 4.12 ± 2.5, p < 0.001) and lower incidence of nausea (43.1% vs. 63.2%, p < 0.05), dizziness (0% vs. 14.0%, p < 0.05), and headache (12.1% vs. 29.8%, p < 0.05). VR could reduce the median HADS scores (9.81 ± 6.1 vs 3.14 ± 3.9, p < 0.001) and blood pressure preoperatively.
CONCLUSIONS: VR intervention can reduce acute postoperative pain with better postoperative recovery and lower preoperative anxiety level in adult female patients undergoing laparoscopic gynecology surgery.