運用虛擬實境介入於局部麻醉手術成人患者降低焦慮之成效 —系統性文獻回顧及統合分析

背景：接受局部麻醉之成人患者在清醒狀態下進行手術，易引發焦慮與恐懼情緒。虛擬實境（Virtual Reality, VR）透過模擬感官回饋與沉浸式體驗，有助於分散注意力、減輕恐懼與焦慮。近年來虛擬實境廣泛應用於醫療處置，然而，至今尚無相關的系統性文獻回顧及統合分析完整的統整運用虛擬實境介入於局部手術患者檢視降低焦慮之成效。目的：本研究旨在系統性回顧及統合分析虛擬實境介入對局部麻醉手術成人患者降低焦慮之成效，探討其介入種類、介入時機、手術種類、評估工具與整體有效性。方法：本研究依據PRISMA報告指引進行系統性文獻回顧及統合分析，並已註冊於PROSPERO（註冊編號：CRD420251021651）。資料搜尋涵蓋六個英文資料庫（PubMed、Cochrane Library、CINAHL EBSCO、Medline、Embase、Web of Science）與兩個中文資料庫（華藝線上圖書館、臺灣碩博士論文知識加值系統），搜尋範圍為2000年1月1日至2024年12月31日前發表之文獻。搜尋時使用中英文關鍵字及其MeSH Terms，並搭配布林邏輯運算元（AND、OR）進行組合檢索。納入條件包括：(1)研究對象為18歲以上之成人；(2)手術麻醉方式採局部麻醉中之浸潤麻醉及腫脹麻醉，以達到暫時麻醉局部的方式；(3)實驗組以虛擬實境為介入；(4)焦慮為最主要或次的研究結果；(5)研究設計為隨機對照試驗、系統性文獻回顧、統合分析；（6）具備可取得之全文且為中、英文文獻。由三位經實證訓練之評讀者採JBI評讀工具進行文獻品質評估，並使用Cochrane ROB 2.0與ROBIS工具進行偏倚風險評估，最後將進行統整及統合分析。結果：本研究納入10篇隨機對照試驗，共845人，使用 Review Manager 5.4，採隨機效果模式進行統合分析。結果顯示虛擬實境介入可顯著降低局部麻醉手術成人患者之焦慮 (p < .0001)，異質性為 I² = 73%。次群組分析指出，沉浸式介入具顯著成效 (p = .0003)，非沉浸式則無顯著差異 (p = .18)；手術中介入效果顯著 (p = .0007)，手術前介入不顯著 (p = .09)。在手術類型方面，牙科、一般外科、整形外科等具顯著成效 (p < .05)，急診外科則無顯著改善 (p = .32)。評估工具以STAI/CSTAI最具穩定性 (p < .01)。此外，虛擬實境亦可有效改善疼痛 (p < .0001)以及穩定脈搏 (p = .02)，並提升病人滿意度 (p < .0001)。結論：本研究結果支持虛擬實境介入可作為有效之非藥物性策略，以降低接受局部麻醉手術成人患者之焦慮，其中介入種類及介入時機以沉浸式虛擬實境及手術中介入成效最為顯著。虛擬實境同時具備改善疼痛、穩定生理指標及提升就醫滿意度等多重效益，顯示其應用潛力。然而，研究亦發現介入成效受介入種類、介入時機、手術類型、文化背景及評估工具差異所影響。未來應加強對不同手術條件與病人特質進行探討，並建議於臨床推廣前進行個別化評估與專業訓練，以提升介入品質與實用性。綜合而言，本研究提供虛擬實境應用於降低局部麻醉患者焦慮的實證依據，未來可作為護理研究、教育與實務發展之參考方向。

Background: Adult patients undergoing surgery under local anesthesia often remain conscious during the procedure, easily triggering anxiety and fear. Virtual Reality (VR), through simulated sensory feedback and immersive experiences, helped divert attention and reduce fear and anxiety. In recent years, VR has been widely applied in medical procedures; however, no systematic review has comprehensively synthesized the effectiveness of VR interventions in reducing anxiety among patients undergoing local anesthesia surgery.Purpose: This study aimed to systematically review and meta-analyze the effectiveness of VR interventions in reducing anxiety among adult patients undergoing surgery under local anesthesia, exploring intervention types, timing, surgery types, assessment tools, and overall efficacy.Methods: This study used the PRISMA reporting guidelines for systematic reviews and meta-analyses and was registered in PROSPERO (Registration No. CRD420251021651). Literature searches were carried out across six English-language databases (PubMed, Cochrane Library, CINAHL EBSCO, Medline, Embase, and Web of Science) and two Chinese-language databases (Airiti Library and the National Digital Library of Theses and Dissertations in Taiwan). The search covered studies published from January 1, 2000, to December 31, 2024. Both English and Chinese keywords and their corresponding MeSH terms were used and combined using Boolean operators (AND, OR) to construct the search strategy. The inclusion criteria were as follows: (1) adult participants aged 18 years or older; (2) the surgical anesthesia method involved local anesthesia, specifically infiltration and tumescent techniques, to achieve temporary regional numbness; (3) the intervention in the experimental group was the application of virtual reality. (4) anxiety measured as a primary or secondary outcome; (5) study designs including randomized controlled trials (RCTs), systematic reviews, or meta-analyses; and (6) full-text articles available in Chinese or English.Three reviewers, each trained in evidence-based practice, independently assessed the quality of the included studies using the JBI critical appraisal tools. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool and the Risk Of Bias In Systematic Reviews (ROBIS) tool. Finally, a synthesis and meta-analysis were performed.Results: Ten RCTs comprising 845 participants were included. Meta-analysis was performed using Review Manager 5.4 with a random-effects model. Results demonstrated that VR intervention significantly reduced anxiety in adult patients undergoing surgery under local anesthesia (p < .0001), with moderate heterogeneity (I² = 73%). Subgroup analyses indicated that immersive VR interventions had significant effects (p = .0003). In contrast, non-immersive VR did not show significant differences (p = .18). Interventions during surgery showed significant anxiety reduction (p = .0007). In comparison, preoperative interventions were not significant (p = .09). Regarding surgery types, dental, general surgery, and plastic surgery exhibited substantial improvements (p < .05). In contrast, emergency surgery showed no significant benefit (p = .32). The State-Trait Anxiety Inventory (STAI/CSTAI) was identified as the most stable assessment tool (p < .01). Additionally, VR intervention effectively alleviated pain (p < .0001), stabilized pulse rate (p = .02), and improved patient satisfaction (p < .0001).Conclusion: Findings supported that VR intervention serves as an effective non-pharmacological strategy to reduce anxiety among adult patients undergoing surgery under local anesthesia, especially immersive VR and intraoperative interventions demonstrating the most pronounced effects. VR also showed multiple benefits, including pain reduction, physiological stabilization, and enhanced patient satisfaction, indicating strong potential for clinical application. However, intervention effectiveness was influenced by factors such as intervention type, timing, surgery type, cultural context, and assessment tools. Future research should focus on tailoring VR interventions to different surgical conditions and patient characteristics, and clinical implementation should include individualized evaluation and professional training to improve intervention quality and applicability. Overall, this study provided empirical evidence for VR use in anxiety reduction for local anesthesia patients, serving as a reference for nursing research, education, and practice development.