虚拟现实在围手术期儿童焦虑管理中的有效性

Abstract

Background

Children undergoing surgery generally experienceanxiety during the perioperative period, which could impact the surgicaloutcome, cause long-term psychological consequences and result in laterhealthcare avoidance. Preoperative anxiety in children is managed using bothpharmacological and non-pharmacological therapies. The latter includedistraction, a tour of the operating room and parental presence until theinduction of anaesthesia. A novel and effective non-pharmacological therapiesis the use of virtual reality to reduce anxiety and pain in children scheduledfor medical procedures. However, the effectiveness of virtual reality in paediatricsurgery has yet to be evaluated in a systematic review.

Objective

To evaluate the effectiveness of virtual reality inthe management of anxiety in paediatric patients during the perioperativeperiod.

Design

Both a systematic review and a meta-analysis ofrandomised controlled trials were performed according to the methods outlinedin the Cochrane Handbook for Systematic Reviews of Interventions Section 8.5and in accordance with the Cochrane Effective Practice and Organisation ofCare. The results are reported as prescribed by the Preferred Reporting Itemsfor Systematic Reviews and Meta-Analyses checklist.

Data sources

A systematic search of randomised controlled trialswas conducted using Medline, SCOPUS, Web of Science, Ovid MEDLINE and CINAHL.

Review methods

Two researchers screened potentially eligiblearticles and then assessed the quality of the reported studies using thecriteria outlined in the Cochrane Handbook for Systematic Reviews ofInterventions Section 8.5 and according to Cochrane Effective Practice andOrganisation of Care.

The data were synthesised using the random-effectsmodels to incorporate the estimated heterogeneity in the weighting.Heterogeneity was tested using the Q and I2 statistics. The τ2 statistic,an estimate of the amount of variation between the included studies, was alsodetermined. Studies whose heterogeneity with respect to primary outcomemeasurements hindered pooling of the results for meta-analysis were summarisednarratively.

Results

Seven studies were eligible for inclusion in thissystematic review. An effect size for anxiety could be determined in six. Theresults support the effectiveness of virtual reality in reducing anxiety inpaediatric patients undergoing elective surgery. The overall effect was supportedby a confidence interval < 0 (PL=−0.341, 95% confidence interval: −0.620 to−0.107) and by heterogenity indexes that were non significant (Q=9.49, p=0.091)or not important (I2=38.64%).

Conclusions

Paediatric patients undergoing elective surgery maybenefit from virtual reality as a distraction method that can reduce anxiety.

PROSPERO register, number: (blinded for Referee).

Keywords

Anxiety

child

surgery

virtual reality

systematic review

meta-analyses

摘要翻译（仅供参考）

背景

接受手术的儿童在围手术期通常会感到焦虑，这可能会影响手术结果，造成长期的心理后果，并导致以后避免医疗保健。使用药物和非药物疗法来管理儿童的术前焦虑。后者包括分散注意力、参观手术室和父母在场，直到麻醉诱导。一种新颖而有效的非药物疗法是使用虚拟现实来减轻计划接受医疗程序的儿童的焦虑和疼痛。然而，虚拟现实在儿科手术中的有效性尚未在系统评价中进行评估。

目的

评估虚拟现实在儿科患者围手术期焦虑管理中的有效性。

设计

随机对照试验的系统评价和荟萃分析均根据 Cochrane 干预系统评价手册第 8.5 节中概述的方法和 Cochrane 有效实践和护理组织进行。结果按照系统评价和元分析的首选报告项目清单的规定报告。

数据源

使用 Medline、SCOPUS、Web of Science、Ovid MEDLINE 和CINAHL 对随机对照试验进行了系统搜索。

综述方法

两名研究人员筛选了可能符合条件的文章，然后使用 Cochrane 干预系统评价手册第 8.5 节中概述的标准和 Cochrane 有效实践和护理组织评估报告研究的质量。

数据是使用随机效应模型合成的，以将估计的异质性纳入加权。使用 Q 和 I 2统计量测试异质性。还确定了τ 2统计量，即对纳入研究之间变异量的估计。对主要结果测量的异质性阻碍荟萃分析结果汇总的研究进行了叙述性总结。

结果

七项研究符合纳入本系统评价的条件。焦虑的影响大小可以确定为六。结果支持虚拟现实在减少接受择期手术的儿科患者焦虑方面的有效性。总体效果得到置信区间 < 0（PL=-0.341，95% 置信区间：-0.620 至 -0.107）和不显着（Q=9.49，p=0.091）或不重要（I 2 = 38.64%）。

结论

接受择期手术的儿科患者可能会受益于虚拟现实作为一种可以减少焦虑的分散注意力的方法。

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