国际口腔医学杂志

国际口腔医学杂志 ›› 2022, Vol. 49 ›› Issue (5): 529-536.doi: 10.7518/gjkq.2022065

• 论著 • 上一篇    下一篇

虚拟现实技术在儿童深龋治疗中对牙科畏惧的干预效果研究

任海霞1,2(),刘颍凤2,梁慧敏1,李家勇2,温春琴2,王春梅1()   

  1. 1.天津医科大学护理学院 天津 300070
    2.天津康复疗养中心口腔科 天津 300191
  • 收稿日期:2021-11-01 修回日期:2022-02-17 出版日期:2022-09-01 发布日期:2022-09-16
  • 通讯作者: 王春梅
  • 作者简介:任海霞，主管护师，硕士，Email：rhxgood2008@126.com

Intervention effect of virtual reality technology on dental fear in the treatment of deep caries in children

Ren Hai-xia1,2(),Liu Yingfeng2,Liang Huimin1,Li Jiayong2,Wen Chunqin2,Wang Chunmei1()   

  1. 1.College of Nursing, Tianjin Medical University, Tianjin 300070, China
    2.Dept. of Stomatology, Tianjin Rehabilitation Center, Tianjin 300191, China
  • Received:2021-11-01 Revised:2022-02-17 Online:2022-09-01 Published:2022-09-16
  • Contact: Chunmei Wang

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摘要：

目的 评估虚拟现实（VR）技术在儿童牙科畏惧症（CDF）患儿深龋治疗过程中，减少疼痛感知和焦虑水平的有效性，分析VR技术缓解患儿DF的效果。 方法 选择5~8岁因患深龋需行活髓切断治疗的患儿为研究对象，经儿童畏惧调查量表-牙科分量表（CFSS-DS）测评共筛选出160例，其中120例为轻度CDF（CFSS-DS评分为16~30分），40例为中度CDF（CFSS-DS评分为31~45分）。将轻度和中度CDF患儿各自随机分组，分别为轻度畏惧VR组（组1，60例）、轻度畏惧告知-演示-操作（TSD）组（组2，60例）、中度畏惧VR组（组3，20例）和中度畏惧TSD组（组4，20例）。组1和组3戴用VR眼镜（VR组）进行干预，组2和组4采用TSD行为引导（TSD组）进行干预。通过心理测评、合作行为评估、生理反应（心率）、疼痛等级、治疗依从性评估2种干预措施缓解儿童焦虑和疼痛的效果。采用VR眼镜适用性评估量表分析其适用性。 结果 160例患儿均完成治疗。治疗开始前，VR组CFSS-DS评分和心率与TSD组比较均无明显差异（P>0.05）。VR组与TSD组比较，治疗前后CFSS-DS评分差值、治疗中心率（中度畏惧组）、疼痛等级、治疗依从性的差异均有统计学意义（P<0.05）；而轻度畏惧组治疗中的心率、各组治疗前和治疗中心率差值与基线比值的差异均无统计学意义（P>0.05）。4组内比较，治疗中的心率值均高于治疗前（P<0.01），除轻度畏惧TSD组治疗前后CFSS-DS评分的差异无统计学意义（P>0.05）外，其余3组治疗前后CFSS-DS评分的差异均有统计学意义（P<0.05）。患儿对VR眼镜适用性方面评价较高。 结论 VR技术在降低CDF患儿的焦虑心理及疼痛感知程度上优于TSD引导，而在降低患儿生理反应（心率）方面的效果与TSD组无明显差异。患儿对VR眼镜的应用具有较高的满意度。

关键词: 虚拟现实技术, 告知-演示-操作行为引导, 儿童, 牙科畏惧症, 疼痛

Abstract:

Objective This study aims to evaluate the effectiveness of the virtual reality (VR) technology in reducing pain perception and anxiety level in children with dental fear (DF) during the treatment of deep caries and analyze the effect of VR technology in relieving DF. Methods Children aged 5-8 years who need pulpotomy for deep caries were selected as research object. A total of 160 children were screened out by the children’s fear survey schedule-dental subscale (CFSS-DS), of which 120 and 40 cases were mild (CFSS-DS score=16-30) and moderate (CFSS-DS score=31-45) DF. Children with mild and moderate DF were randomly divided into four groups: mild DF VR (group 1, 60 cases), mild DF Tell-Show-Do (TSD; group 2, 60 cases), moderate DF VR (group 3, 20 cases), and moderate DF TSD (group 4, 20 ca-ses) groups. Groups 1 and 3 were intervened by wearing VR glasses (VR group), whereas groups 2 and 4 were intervened by TSD behavior guidance (TSD group). The effects of two intervention measures on alleviating children’s DF were evaluated using psychological evaluation (i.e., CFSS-DS), cooperative behavior evaluation, physiological response (heart rate), pain degree, and treatment compliance evaluation. VR glasses’ applicability assessment scale was used to analyze its applicability. Results All 160 children completed treatment. No significant difference in the CFSS-DS score and heart rate before treatment was observed between VR and TSD groups (P>0.05). The CFSS-DS score differences before and after treatment, heart rate du-ring treatment (in group 3), pain grade, and treatment compliance of TSD and VR groups were statistically significant (P<0.05). However, no significant difference was observed in heart rate during treatment between groups 1 and 2 (P>0.05). The ratio of the heart rate difference (before and during treatment) to baseline was also not statistically significant (P>0.05). The intragroup comparison and heart rates during treatment were higher than those before treatment in four groups (P<0.01). Significant differences in CFSS-DS score differences before and after treatment were observed in groups 1, 3, and 4 (P<0.05) but not in group 2 (P>0.05). Children had high evaluation on the applicability of VR glasses. Conclusion The VR technology was superior to TSD guidance in reducing the anxiety and pain degree of children with DF, but no significant difference was observed in reducing the physiological response (heart rate) of children compared with TSD guidance. Children were satisfied with the application of VR glasses.

Key words: virtual reality technology, Tell-Show-Do behavior guidance, children, dental fear, pain

中图分类号: 

  • R 78

表　1

患儿一般资料"

测量项目轻度CDF中度CDF
试验组（n=60）对照组（n=60）P值试验组（n=20）对照组（n=20）P值
年龄/岁6.12±0.136.20±0.130.4435.98±0.216.35±0.250.265
性别/例男34370.0719110.655
女2623119
治疗前CFSS-DS评分22.93±0.5822.70±0.670.79337.90±0.7936.70±1.160.399

表　2

治疗前后CFSS-DS量表评分"

组别治疗前治疗后治疗前后差值P1 值a
轻度畏惧VR22.93±0.5819.77±0.563.17±0.490.000**
轻度畏惧TSD22.70±0.6721.33±0.761.37±0.750.073
中度畏惧VR37.90±0.7925.60±1.3412.30±0.940.000**
中度畏惧TSD36.70±1.1633.15±1.213.55±1.100.004**
P2值b0.7900.1000.047*
P3值c0.4000.000**0.000**

表　3

Venham临床焦虑及合作行为等级评估"

组别等级秩平均值P值
012345
轻度畏惧VR30164100058.680.540a
轻度畏惧TSD27158100062.32
中度畏惧VR104240016.400.020*b
中度畏惧TSD46050524.60

表　4

治疗前和治疗中心率测量值"

组别心率

Q值

[（治疗中－治疗前）/治疗前]

P1 值a
治疗前治疗中
轻度畏惧VR97.07±1.56109.43±1.690.13±0.010.000**
轻度畏惧TSD96.72±1.78107.52±2.400.11±0.010.000**
中度畏惧VR97.50±4.23110.90±4.460.14±0.020.000**
中度畏惧TSD108.05±4.53126.55±4.870.18±0.040.000**
P2值b0.8830.5000.250
P3值c0.0970.023*0.395

表　5

局部注射期间疼痛等级评估"

组别等级秩平均值P值
012345
轻度畏惧VR3814260054.570.039*a
轻度畏惧TSD2622624066.43
中度畏惧VR144200017.100.041*b
中度畏惧TSD87030223.90

表　6

治疗依从性评估"

组别等级依从例数依从率/%P值
好较好差
轻度畏惧VR564060100.000.000**a
轻度畏惧TSD183485286.67
中度畏惧VR182020100.000.000**b
中度畏惧TSD21351575.00

表　7

VR眼镜适用性评估"

测量指标级别例数构成比/%
眼镜舒适性十分舒适7695.0
舒适22.5
比较舒适22.5
比较不舒适00.0
不舒适00.0
疲劳感完全不疲劳80100.0
有点疲劳00.0
特别疲劳00.0
十分疲劳00.0
游戏吸引程度/分>57897.5
≤522.5
意愿性愿意7695.0
无所谓22.5
不愿意22.5
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