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虚拟现实暴露疗法降低行腹腔镜妇科手术女性患者的急性术后疼痛：一项随机对照试验（RCT）研究。

Virtual reality exposure reduce acute postoperative pain in female patients undergoing laparoscopic gynecology surgery: A Randomized Control Trial (RCT) study.

机构信息

Department of anesthesiology, Beijing Fuxing Hospital, Capital Medical University, Beijing 100038, China.

Department of anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.

出版信息

J Clin Anesth. 2024 Oct;97:111525. doi: 10.1016/j.jclinane.2024.111525. Epub 2024 Jun 12.

DOI:10.1016/j.jclinane.2024.111525

PMID:38870701

Abstract

STUDY OBJECTIVE

Few studies have focused on the effect of virtual reality (VR) exposure on postoperative acute pain in adult female patients undergoing gynecology surgery.

DESIGN

A randomized control trial (RCT) study.

SETTING

At Beijing Fuxing Hospital.

PATIENTS

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).

INTERVENTIONS

Patients in the VR group received 15 min of VR video viewing before surgery.

MEASUREMENTS

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.

MAIN 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 χ = 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.

摘要

研究目的

鲜有研究关注虚拟现实（VR）暴露对行妇科手术的成年女性患者术后急性疼痛的影响。

设计

随机对照试验（RCT）研究。

地点

北京复兴医院。

患者

连续纳入 115 名年龄在 20 岁至 60 岁之间、ASA 身体状况 I-II 的患者，并将其随机分为 VR 组（n=58）或对照组（n=57）。

干预

VR 组患者在术前接受 15 分钟 VR 视频观看。

测量

主要结局为术后 8 小时的急性术后疼痛，采用视觉模拟评分（VAS）评估。次要结局包括术后 24 小时内镇痛药的使用、中度疼痛的发生率和术后恢复情况。术前还使用医院焦虑和抑郁量表（HADS）评估患者的情绪状态。

主要结果

术后 30 分钟[2（1，2）比 3（2，3）]、2 小时[2（2，3）比 4（3，4）]、4 小时[3（2，4）比 4（4，5）]、8 小时[3（2，4）比 4（4，5）]、12 小时[2（2，3）比 4（3，4）]、24 小时[1（1，2）比 3（2，3）]时，VAS 评分均降低。广义估计方程（GEE）表明 VR 干预与术后 VAS 值呈负相关（β=-0.830，SE=0.199，95%CI（-1.220，-0.439），Wald χ=17.359，p<0.05），同时，VR 还降低了术后 8 小时中度疼痛（VAS>4）的发生率（12.1%比 31.0%，p=0.013）。然而，术后 24 小时曲马多的使用量没有变化。VR 组患者的睡眠质量更好（6.33±2.3 比 4.12±2.5，p<0.001），恶心（43.1%比 63.2%，p<0.05）、头晕（0%比 14.0%，p<0.05）和头痛（12.1%比 29.8%，p<0.05）的发生率较低。VR 可降低成年女性腹腔镜妇科手术患者术前的中位数 HADS 评分（9.81±6.1 比 3.14±3.9，p<0.001）和血压。