文章摘要
沉浸式虚拟现实对老年患者经尿道前列腺切除术后早期焦虑的影响
Effect of immersive virtual reality distraction on postoperative anxiety in elderly patients undergoing transurethral resection of the prostate
  
DOI：10.12089/jca.2023.09.001
中文关键词: 焦虑  虚拟现实  老年  经尿道前列腺切除术  谵妄
英文关键词: Anxiety  Virtual reality  Aged  Transurethral resection of the prostate  Delirium
基金项目:河北省卫生健康委员会医学科学研究计划（20200803）
作者单位E-mail
曹珑璐 050051,石家庄市,河北省人民医院麻醉科  
吴晓倩 050051,石家庄市,河北省人民医院麻醉科  
段然 050051,石家庄市,河北省人民医院麻醉科  
李攀 050051,石家庄市,河北省人民医院麻醉科  
韩霜 050051,石家庄市,河北省人民医院麻醉科  
李建立 050051,石家庄市,河北省人民医院麻醉科 hblijianli@163.com 
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中文摘要:
      
目的 探讨术中沉浸式虚拟现实（VR）对老年患者经尿道前列腺切除术（TURP）后早期焦虑和术后谵妄（POD）的影响。
方法 选择2022年2—8月择期在腰-硬联合麻醉下行TURP的老年患者80例，年龄65～80岁，BMI 18～28 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：对照组（C组）和虚拟现实组（VR组），每组40例。C组接受标准化麻醉方案。VR组接受标准化麻醉管理的同时佩戴PICO Neo3 VR一体机，进行沉浸式视听体验。采用医院焦虑-抑郁量表焦虑亚量表（HADS-A）于入室后和PACU转出前评估焦虑情况。采用ELISA法检测入室后、PACU转出前血浆5-羟色胺（5-HT）浓度。采用意识模糊法（CAM量表）评估术后3 d POD的发生情况。记录术中硬膜外追加局麻药和咪达唑仑使用情况、术中低血压、低氧血症及体动发生情况。采用局部/区域阻滞麻醉评估量表（EVAN-LR）评价围术期患者满意度情况。记录术后补救镇痛、术后恶心呕吐（PONV）、术后首次肛门排气时间及术中不良回忆的发生情况。
结果 与C组比较，PACU转出前VR组焦虑发生率明显降低，血浆5-HT浓度明显升高，术后3 d POD发生率明显降低，术中硬膜外追加局麻药和使用咪达唑仑的比例明显降低，术中低血压和体动的发生率明显降低，EVAN-LR量表中患者舒适度和疼痛感满意度升高，术后补救镇痛率和PONV发生率明显降低，术后首次肛门排气时间明显缩短（P＜0.05）。
结论 术中沉浸式VR体验可有效缓解老年患者经尿道前列腺切除术后早期焦虑，降低POD的发生。
英文摘要:
      
Objective To evaluate the effect of intraoperative immersive virtual reality (VR) distraction on postoperative anxiety and postoperative delirium (POD) in elderly patients undergoing transurethral resection of the prostate (TURP).
Methods Eighty elderly patients, aged 65-80 years, BMI 18-28 kg/m2, ASA physical status Ⅱ or Ⅲ, undergoing TURP under combined epidural and spinal anesthesia from February to August 2022 were selected, and the patients divided into two groups using a random number table method: control group (group C) and VR group (group VR), 40 patients in each group. The patients in the two groups were both accepted standardized anesthesia management, while those in group VR were equipped with VR device of PICO Neo3, then immersive visual and auditory universe were conducted. The hospital anxiety and depression scale-anxiety (HADS-A) scale was used to evaluate anxiety after entering the room and before PACU transferring out. Plasma 5-hydroxy tryptamine (5-HT) concentration after entering the room and befor PACU transferring out were detected by ELISA. Confusion assessment method (CAM) was used to evaluate the occurrence of POD 3 days after surgery. The occurrence of intraoperative adverse events such as hypotension, hypoxemia, body movement, and the number of patients who needed local anesthetics and midazolam were recorded. Evaluation of the experience of locoregional anesthesia scale (EVAN-LR) was used to assess patients' satisfaction in perioperative period. Postoperative remedial analgesia and postoperative nausea and vomiting (PONV), and the time of first postoperative anal exhaust and the occurrence of adverse intraoperative recall were also recorded.
Results Compared to group C, the incidence of anxiety was significantly decreased, plasma 5-HT concentration was significantly increased before PACU transferring out, the incidence of POD was significantly decreased 3 days after surgery, the need for intraoperative local anesthetics and midazolam were significantly reduced, and the incidence of intraoperative adverse events was significantly decreased, patients' comfort level and pain satisfaction of EVAN-LR were significantly increased, the incidence of postoperative analgesia and PONV were significantly decreased, and the time of first flatus was significantly shortened in group VR (P < 0.05).
Conclusion Immersive VR distraction can effectively relieve anxiety in elderly patients undergoing TURP, with a lowered POD incidence.
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