運用虛擬實境遊戲降低燒燙傷患者換藥疼痛之成效：系統性文獻回顧

The Effectiveness of Virtual Reality Therapy to Reduce Pain during Burn Wound Dressing Changes: A Systematic Review

謝伶瑜(Ling-Yu Hsieh) ； 廖彥琦(Yen-Chi Liao)

《台灣醫學》 20卷4期 (2016/07) Pp. 355-363

https://doi.org/10.6320/FJM.2016.20(4).3

摘要

處理燒燙傷傷口對患者而言是一個非常痛苦的經驗，搭配非藥物之輔助療法是減輕換藥疼痛的不二法則，而介入虛擬實境於換藥過程，便是希望能藉由注意力轉移讓個案暫時脫離苦痛的現實世界。本文目的為統整運用虛擬實境減緩燒燙傷換藥疼痛之系統性文獻回顧並進行更新。搜尋2015年8月以前的中、英文文獻，資料庫包含Cochrane、PubMed、Medline、ProQuest及華藝線上圖書館，中、英文關鍵字包含：燒燙傷、虛擬實境、換藥疼痛、burn、virtual reality、pain。文獻選取標準為運用虛擬實境於換藥疼痛減輕之隨機控制試驗，並以modified Jadad scale作為研究品質篩選工具。共納入九篇研究，包含204位燒燙傷病人，樣本數範圍為7至42人。虛擬實境遊戲內容以「下雪世界」為主，換藥過程前即會讓研究對象開始操作遊戲至換藥結束後再持續短暫時間，六篇研究支持透過虛擬實境遊戲能有效改善燒燙傷換藥的疼痛；在安全性方面，八篇研究指出虛擬實境遊戲未造成任何負向影響或僅有極低程度噁心感。研究結果可作為醫護人員結合非藥物措施管理燒燙傷換藥疼痛之參考，未來仍須進行嚴謹、盲化、大規模的隨機控制試驗，以持續更新此實證結果。

關鍵字

虛擬實境 ； 燒燙傷 ； 換藥疼痛 ； 系統性文獻回顧

並列摘要

Wound care on patients with burn injuries is a very suffering experience. Nonpharmacologic techniques based adjuncts to pain medications are necessary. However, immersive virtual reality (VR) may diverts attention away from the pain during wound dressing change by immersing patients in a computer generated environment. The aim of this study was to update the evidence related to the effectiveness of VR for reducing pain during burn wound dressing changes. The review focused on studies published before August 2015, and included searches of the following databases: Cochrane Library, PubMed, MEDLINE, ProQuest and Airiti Library. We searched for keywords including burn injury, VR, and pain. Inclusion criteria was to identify all randomized controlled trials (RCTs) that evaluated the efficacy of VR to reduce pain during burn wound dressing changes. Study quality was assessed using the Modified Jadad scale. Nine RCTs that enrolled a total of 204 burn patients were included. The sample size ranged from 7 to 42 patients. A visual display of SnowWorld was constructed. The patients interacts with the virtual world prior to the wound care and after completing the changing of wound dressing that they would like to play some more. Six studies supporting that VR was an effective nonpharmacologic pain reduction technique for burn patients during wound care. About safety, eight studies reported VR with no side effects or mean nausea ratings were negligible. These results can be used as a reference for pain management during burn wound dressing change in conjunction with nonpharmacologic method. However, further studies with larger sample sizes are required to update these results.

並列關鍵字

virtual reality ； burn ； pain during wound dressing change ； systematic review

參考文獻

連心瑜、莊文怡、楊瑞永等：虛擬實境應用於一位燒燙傷兒童疼痛減輕成效之初探。長庚護理 2007;18:294-306。[Lien SY, Chuang WY, Yang JY, et al: An exploration of virtual reality for the relief of pediatric burn pain. Chang Gung Nursing 2007; 18: 294-306.]"

Malloy KM, Milling LS: The effectiveness of virtual reality distraction for pain reduction: a systematic review. Clin Psychol Rev 2010;30:1011-108."

Hoffman HG, Richards TL, Coda B, et al: Modulation of thermal pain-related brain activity with virtual reality: Evidence from fMRI. Neuroreport 2004;15:1245-8."

Furman E, Jasinevicius TR, Bissada NF, et al: Virtual reality distraction for pain control during periodontal scaling and root planing procedures. J Am Dent Assoc 2009;140:1508-16."

Schneider SM, Prince-Paul M, Allen MJ, et al: Virtual reality as a distraction intervention for women receiving chemotherapy. Oncol Nurs Forum 2004;31:81-8."