Luo Wenjun, Chen Chunqu, Zhou Weijian, Cao Angyang, Zhu Weichao, Zhou Yanling, Xu Zhipeng, Wang Jianhua, Zhu Binbin
School of Medicine, Ningbo University, Ningbo, Zhejiang, China; Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China.
School of Medicine, Ningbo University, Ningbo, Zhejiang, China; Department of Radiology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China.
J Pediatr Urol. 2023 Apr;19(2):201-210. doi: 10.1016/j.jpurol.2022.10.023. Epub 2022 Oct 20.
The aim of this study was to evaluate the effects of the biophilic virtual reality (BVR) method on children's pain and anxiety undergoing circumcision.
This randomized controlled study used a parallel trial design guided by the CONSORT checklist. A total of 106 children were included in the analysis. Intraoperative anxiety was assessed by using the simplified Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS), Visual Analogue Scale (VAS), heart rate (HR), and Anxiety index (Ai). Intraoperative pain was assessed by using the Faces Pain Scale-Revised (FPS-R), and Pain index (Pi). The Pearson correlation analysis was used to analyze the relationship between Ai and the CmYPAS. The primary outcomes were CmYPAS, VAS, and FPS-R, which were analyzed using the Kruskal-Wallis test.
Baseline variables were not significantly different between the BVR group (34 patients), the indoor virtual reality (IVR) group (36 patients), and the blank control group (36 patients). The CmYPAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (25.0[22.9-29.2], 22.9[22.9-29.2], 33.3[33.3-38.5] respectively; P < 0.001). The VAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (5.0[3.0-7.0], 3.0[2.0-5.0], 6.0[5.0-8.8] respectively; P < 0.001). The FPS-R scores during surgery were significantly lower in the BVR group and IVR group versus the blank control group (2.0[1.8-4.2], 3.0[2.0-4.8], 5.5[5.0-8.0], respectively; P < 0.001). At removal of the foreskin, Pi were significantly lower in the BVR group and IVR group versus the blank control group (6.9[4.1], 7.7[3.3], 9.8[6.2] respectively; P = 0.033). The Ai scores at each time point were significantly lower in the BVR group and IVR group versus the control (P = 0.015, P = 0.006 respectively). The correlation analysis of Ai (at removal of the foreskin) and CmYPAS scores in children showed that the Pearson correlation coefficient was 0.194 (P = 0.046).
This is the first RCT to investigate the effects of BVR in children undergoing circumcision. This study demonstrates a reduction in pediatric intraoperative pain and anxiety with the use of virtual reality (VR).
Intraoperative VR may be an effective noninvasive modality for reducing pain and anxiety during circumcision. Pi and Ai might be used to assess subjective pain and anxiety in patients.
本研究旨在评估亲生物虚拟现实（BVR）方法对接受包皮环切术儿童的疼痛和焦虑的影响。
本随机对照研究采用由CONSORT清单指导的平行试验设计。共有106名儿童纳入分析。术中焦虑采用改良耶鲁术前焦虑量表中文版（CmYPAS）、视觉模拟量表（VAS）、心率（HR）和焦虑指数（Ai）进行评估。术中疼痛采用面部疼痛量表修订版（FPS-R）和疼痛指数（Pi）进行评估。采用Pearson相关分析分析Ai与CmYPAS之间的关系。主要结局指标为CmYPAS、VAS和FPS-R，采用Kruskal-Wallis检验进行分析。
BVR组（34例患者）、室内虚拟现实（IVR）组（36例患者）和空白对照组（36例患者）之间的基线变量无显著差异。BVR组和IVR组手术期间的CmYPAS评分显著低于空白对照组（分别为25.0[22.9-29.2]、22.9[22.9-29.2]、33.3[33.3-38.5]；P<0.001）。BVR组和IVR组手术期间的VAS评分显著低于空白对照组（分别为5.0[3.0-7.0]、3.0[2.0-5.0]、6.0[5.0-8.8]；P<0.001）。BVR组和IVR组手术期间的FPS-R评分显著低于空白对照组（分别为2.0[1.8-4.2]、3.0[2.0-4.8]、5.5[5.0-8.0]；P<0.001）。在包皮环切时，BVR组和IVR组的Pi显著低于空白对照组（分别为6.9[4.1]、7.7[3.3]、9.8[6.2]；P=0.033）。BVR组和IVR组在每个时间点的Ai评分均显著低于对照组（分别为P=0.015、P=0.006）。对儿童在包皮环切时的Ai与CmYPAS评分进行相关分析，结果显示Pearson相关系数为0.194（P=0.046）。
这是第一项研究BVR对接受包皮环切术儿童影响的随机对照试验。本研究表明，使用虚拟现实（VR）可降低小儿术中疼痛和焦虑。
术中VR可能是一种有效的非侵入性方法，可减轻包皮环切术中的疼痛和焦虑。Pi和Ai可用于评估患者的主观疼痛和焦虑。
