音乐可以改善一些术后结果


  【24drs.com】根据得自72篇试验的系统性回顾与统合分析结果,与没有听音乐的外科病患相比,听音乐的外科病患可以显著减少焦虑以及有较佳的术后满意度。英国伦敦玛莉皇后大学Jenny Hole等人在在线发表于8月12日Lancet期刊的报告指出,这些患者也比较少需要止痛药物,且比较少感到疼痛。
  
  这篇分析纳入的随机控制试验,比较了标准照护加上在术前、术中、术后开始听音乐以及其它非药物介入方式,研究对象是进行任何类型手术的成年患者,排除了中枢神经系统或头颈部手术。研究者有兴趣的结果包括术后疼痛、止痛药需求、焦虑、感染率、伤口愈合、费用、住院天数以及病患满意度。
  
  作者们报告指出,相较于对照组,介入组在焦虑、疼痛、止痛药需求、满意度等方面的标准化平均差异分别是-0.68、-0.77、-0.37与1.09。他们写道,住院天数方面没有观察到差异,这些研究也都没有探讨音乐对于感染、伤口愈合率或费用等的影响。
  
  根据分析,术前听音乐与大幅减少疼痛、止痛药需求与焦虑等有关,其次依序是术中与术后听音乐。
  
  作者们报告指出,就算是在全身麻醉时,音乐也可减少疼痛,但是,对于疼痛的这个影响在病患有意识时更大。
  
  在被允许自己选择音乐者中(不论是自己带来或从医院提供的音乐中选择),疼痛情况与止痛药的使用并无显著减少。然而,相较于没有选择音乐者,选择音乐的病患,焦虑有些微但不显著的增加。
  
  作者们写道,认知活动如听音乐会影响疼痛的感知与不愉快,使人对疼痛的感觉降低。这或许是可以解释音乐之影响的可能机转。另一种可能的机转是,降低自主神经系统活性,例如降低脉搏与呼吸速率以及降低血压。
  
  根据他们的结果,作者们相信,已有足够的研究显示,进行手术的所有病患都应听音乐。他们强调,病患应该可以选择他们想听的音乐类型,但是这些音乐不可以干扰医疗团队之间或与病患间的沟通。
  
  澳洲昆士兰Bond大学的Paul Glasziou博士在相关评论中写道,音乐是简单又便宜的介入方式,减少大多数病患在进行手术时的暂时不适。他指出,有类似效果的药物可能会有极大商机。
  
  Glasziou博士写道,人们对音乐反应的复杂度会对它的医疗用途带来一些不确定性。虽然花费低且可改善病患经验,让是否使用音乐这个问题似乎是显而易见。而实际上如何使用则仍不清楚。他指出,播放莫札特或玛丹娜都可能会使某些人感到平静、使某些人感到刺激。
  
  他指出,不过,其它这些研究问题不会妨碍目前让病患作这些理性选择与执行,当我下次执刀手术时,我会带一些莫札特音乐和这篇系统回顾资料。
  
  资料来源:http://www.24drs.com/
  
  Native link:Music Improves Some Postoperative Outcomes

Music Improves Some Postoperative Outcomes

By Diana Phillips
Medscape Medical News

Surgical patients who listened to music were significantly less anxious and more satisfied postoperatively compared with those who did not, according to a systematic review and meta-analysis of data from 72 trials. They also needed less pain medication and reported significantly less pain, Jenny Hole, MBBS, from Queen Mary University of London, United Kingdom, and colleagues report in an article published online August 12 in the Lancet.

The analysis included randomized controlled trials that compared any type of music initiated before, during, or after surgery with standard care of other nondrug interventions in adult patients undergoing any form of surgery, excluding central nervous system or head and neck procedures. The outcomes of interest were postoperative pain, analgesia needs, anxiety, infection rates, wound healing, costs, length of stay, and patient satisfaction.

The standardized mean differences in outcomes from the start of the study for anxiety, pain, need for pain medication, and satisfaction in the intervention group relative to controls were, respectively, ?0.68, ?0.77, ?0.37, and 1.09, the authors report. No differences were observed in length of stay, and none of the studies investigated the effects of music on infections, wound healing rates, or costs, they write.

Music played preoperatively was associated with the greatest reduction in pain, analgesia, and anxiety, followed by intraoperative and postoperative music, according to the analysis.

"Music reduced pain, even when given under general anaesthetic, but the intervention had an increased effect on pain when patients were conscious," the authors report.

Nonsignificant reductions in pain and analgesia use were observed among patients who were allowed to choose the music, either from their personal playlist or one that was provided to them. "However, we recorded a slight but non-significant increase in anxiety when patients had a choice of music compared with when they had no choice," the authors note.

"Cognitive activities such as listening to music can affect perceived intensity and unpleasantness of pain, enabling patients' sensation of pain to be reduced," the authors write, suggesting a possible mechanism to explain the effects of music on outcomes. "Another potential mechanism could be reduced autonomic nervous system activity, such as reduced pulse and respiration rate and decreased blood pressure."

On the basis of their findings, the authors believe that "sufficient research has been done to show that music should be available to all patients undergoing operative procedures." Patients should be able to choose the type of music they listen to, but the music must not interfere with the medical team's communications with each other or the patient, they stress.

Paul Glasziou, PhD, from Bond University, Queensland, Australia, agrees, writing in an accompanying comment that "music is a simple and cheap intervention, which reduces transient discomforts for many patients undergoing surgery." He notes that "[a] drug with similar effects might generate substantial marketing."

The complexity of human reaction to music does introduce some uncertainties about its use medically, Dr Glasziou writes. Although the low-cost and improved patient experience "make the question of whether to use music seem obvious," he says, exactly how it should be used is still unclear. "Piped Mozart or Madonna might soothe some and irritate others," he notes.

However, these remaining research questions "should not inhibit implementation of a sensible choice for patients now," he adds. "For my next surgery, I will bring some Mozart and a copy of this systematic review."

The study authors and commenter have disclosed no relevant financial relationships.

Lancet. Published online August 13, 2015

    
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