麻醉方式：虚拟现实技术的应用

本文由“小麻哥的日常"授权转载

摘要译文(供参考)

手外科手术中沉浸式虚拟现实与麻醉监护的比较：

一项随机对照试验

前言：

手外科的常见麻醉实践结合了术前区域阻滞麻醉和术中监测麻醉（MAC）。

尽管有足够的区域阻滞麻醉，但患者可能会接受一定剂量的术中镇静剂，这可能导致过度镇静和潜在的可避免的并发症。

事实证明，虚拟现实是患者和麻醉医生的宝贵工具，它可以分散人们处理有害刺激的注意力，从而减少镇静药物的使用，降低过度镇静的风险，同时不会对患者满意度产生负面影响。

目的：

我们的假设是，与常规监测麻醉相比，术中使用VR可减少择期手外科手术期间的镇静剂量，而不会降低患者满意度。

方法：

40例接受手外科手术的成人随机接受术中VR加MAC或常规MAC。

两组患者均接受了由医生自行决定的术前区域麻醉。

术中，VR小组通过头戴式显示器观看他们选择的节目。

主要结果为术中异丙酚每小时剂量（mg·hr-1）。

次要结果包括患者报告的疼痛和焦虑、总体满意度、功能结果和麻醉后恢复室（PACU）住院时间（LOS）。

结果：

在40名入选患者中，34名患者完成了围手术期试验。

VR组患者每小时接受异丙酚的量明显少于对照组（平均值（±标准差SD）：125.3（±296.0）mg·hr-1比750.6（±334.6）mg·hr-1，p<0.001）。

两组患者报告的总体满意度没有显著差异（0-100分，中位数（IQR）92（77-100）vs 100（100-100），VR vs对照，p=0.087）。

两组患者的PACU疼痛评分、围手术期阿片类镇痛剂剂量或术后功能结果无显著差异。

VR组的PACU LOS显著降低（53.0（43.0-72.0）分钟vs 75.0（57.5-89.0）分钟，p=0.018）。

结论：

手外科手术中的沉浸式VR可显著降低术中异丙酚剂量和PACU LOS，而不会对患者报告的关键结果产生负面影响。

图1

合并报告标准试验（CONSORT）流程图。

图2 

 A）使用VR设备的研究患者图像。B） 典型沉浸式VR的屏幕截图，以及研究人员的文本交流示例。这份手稿中的个人已经书面同意发布这张图片（如PLOS同意书中所述）。

图3

A）各组异丙酚平均总剂量B）各组PACU平均住院时间。

Virtual reality immersion compared to monitored anesthesia care for hand surgery:

A randomized controlled trial

Introduction:

Common anesthesia practice for hand surgery combines a preoperative regional anesthetic and intraoperative monitored anesthesia care (MAC). Despite adequate regional anesthesia, patients may receive doses of intraoperative sedatives which can result in oversedation and potentially avoidable complications. VR could prove to be a valuable tool for patients and providers by distracting the mind from processing noxious stimuli resulting in minimized sedative use and reduced risk of oversedation without negatively impacting patient satisfaction. Our hypothesis was that intraoperative VR use reduces sedative dosing during elective hand surgery without detracting from patient satisfaction as compared to a usual care control.

Methods: Forty adults undergoing hand surgery were randomized to receive either intraoperative VR in addition to MAC, or usual MAC. Patients in both groups received preoperative regional anesthesia at provider discretion. Intraoperatively, the VR group viewed programming of their choice via a head-mounted display. The primary outcome was intraoperative propofol dose per hour (mg · hr-1). Secondary outcomes included patient reported pain and anxiety, overall satisfaction, functional outcome, and post anesthesia care unit (PACU) length of stay (LOS).

Results: Of the 40 enrolled patients, 34 completed the perioperative portion of the trial. VR group patients received significantly less propofol per hour than the control group (Mean (±SD): 125.3 (±296.0) vs 750.6 (±334.6) mg · hr-1, p<0.001). There were no significant differences between groups in patient reported overall satisfaction, (0-100 scale, Median (IQR) 92 (77-100) vs 100 (100-100), VR vs control, p = 0.087). There were no significant differences between groups in PACU pain scores, perioperative opioid analgesic dose, or in postoperative functional outcome. PACU LOS was significantly decreased in the VR group (53.0 (43.0-72.0) vs 75.0 (57.5-89.0) min, p = 0.018).

Conclusion: VR immersion during hand surgery led to significant reductions in intraoperative propofol dose and PACU LOS without negatively impacting key patient reported outcomes.

Fig 1. Consolidated Standards of Reporting Trials (CONSORT) flow diagram.

Fig 2 A) Image of a study patient using the VR equipment. B) Screenshot of a typical immersive environment with an example of text communication from study personnel. The individual in this manuscript has given written informed consent (as outlined in PLOS consent form) to publish this image.

Fig 3 A) Propofol mean total dose by group B) PACU median length of stay by group.

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编辑：Michel.米萱

校对：Mijohn.米江

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