Abstract:

Objective To explore the intervention effect of preoperative virtual reality scene simulation training on the incidence of postoperative delirium in elderly patients with lung cancer，and to analyze its potential mechanism，so as to provide scientific bases for clinical nursing. Methods Using a non-synchronous controlled trial design，160 elderly patients who were scheduled to undergo radical lung cancer surgery in a tertiary A hospital in Shanghai from March 2024 to February 2025 were conveniently sampled and divided into an experimental group（80 cases） and a control group（80 cases）. The experimental group added multi module virtual reality scene simulation training on the basis of routine intervention，including cognitive pre adaptation throughout the surgical process，postoperative rehabilitation behavior training，and multi sensory relaxation intervention. The control group received routine health education and basic relaxation training. The incidence of postoperative delirium，preoperative anxiety，intraoperative physiological stress（MAP，HR），and postoperative hospital stay were compared between 2 intervention groups. Results The experimental group ultimately included 77 cases，while the control group ultimately included 78 cases. The incidence of postoperative delirium in the experimental group was 3.90%，lower than 14.10% in the control group，and the difference was statistically significant（χ²=4.913，P=0.027）. The odds ratio was 0.247（95%CI：0.072~0.851）. The anxiety score was（5.42±1.63） points at 30 min before operation in the experimental group，significantly lower than（7.76±2.09） points in the control group（P<0.001）. The mean arterial pressure was（105.02±8.27） mmHg and the heart rate was（92.73±7.96） beats per minute before anesthesia induction，which were lower than （109.75±8.53） mmHg and （96.84±8.19） beats per minute in the control group，and the differences were statistically significant（P<0.05）. The postoperative hospitalization time of the experimental group was 4（4，5） days，shorter than 5（4，6） days of the control group，and the difference was statistically significant（P=0.046）. Conclusion Preoperative virtual reality scene simulation training can effectively reduce the incidence of postoperative delirium in elderly patients with lung cancer，reduce preoperative anxiety and physiological stress response，and shorten postoperative hospital stays. It can provide non-drug intervention strategies for optimizing perioperative management of elderly patients with lung cancer.

Key words: Elderly Lung Cancer, Virtual Reality, Radical Resection of Lung Cancer, Delirium, Preoperative Anxiety, Perioperative Nursing

摘要：

目的 探讨术前虚拟现实场景模拟训练对老年肺癌患者术后谵妄的干预效果，为临床护理提供科学依据。方法 采用非同期对照试验设计，便利抽样选取2024年3月至2025年2月上海市某三级甲等综合医院拟行肺癌根治术的老年患者160例，分为试验组（80例）和对照组（80例）。试验组在常规干预基础上增加多模块虚拟现实场景模拟训练，包括手术全流程认知预适应、术后康复行为训练及多感官放松干预。对照组接受常规健康教育及基础放松训练。比较两组术后谵妄发生率及术前焦虑情况、术中生理应激反应、术后住院时间的差异。结果 最终试验组纳入77例，对照组纳入78例。试验组术后谵妄发生率为3.90%，低于对照组的14.10%（χ²=4.913，P=0.027），比值比为0.247（95%CI为0.072~0.851）。试验组术前30 min焦虑评分（5.42±1.63）分，低于对照组的（7.76±2.09）分（P<0.001），麻醉诱导前试验组平均动脉压为（105.02±8.27）mmHg（1 mmHg=0.133 kPa）、心率为（92.73±7.96）次/分，对照组平均动脉压为（109.75±8.53）mmHg、心率为（96.84±8.19）次/分，两组比较，差异具有统计学意义（P<0.05）。试验组术后住院时间4（4，5）d短于对照组的5（4，6）d，差异有统计学意义（P=0.046）。结论 实施术前虚拟现实场景模拟训练可有效降低老年肺癌患者术后谵妄发生率，减轻术前焦虑和生理应激反应，并缩短术后住院时间，可为优化老年肺癌患者围手术期管理提供非药物干预策略。

关键词: 老年肺癌, 虚拟现实, 肺癌根治术, 谵妄, 术前焦虑, 围手术期护理