音樂可以改善一些術後結果


  【24drs.com】根據得自72篇試驗的系統性回顧與統合分析結果,與沒有聽音樂的外科病患相比,聽音樂的外科病患可以顯著減少焦慮以及有較佳的術後滿意度。英國倫敦瑪莉皇后大學Jenny Hole等人在線上發表於8月12日Lancet期刊的報告指出,這些患者也比較少需要止痛藥物,且比較少感到疼痛。
  
  這篇分析納入的隨機控制試驗,比較了標準照護加上在術前、術中、術後開始聽音樂以及其他非藥物介入方式,研究對象是進行任何類型手術的成年患者,排除了中樞神經系統或頭頸部手術。研究者有興趣的結果包括術後疼痛、止痛藥需求、焦慮、感染率、傷口癒合、費用、住院天數以及病患滿意度。
  
  作者們報告指出,相較於對照組,介入組在焦慮、疼痛、止痛藥需求、滿意度等方面的標準化平均差異分別是-0.68、-0.77、-0.37與1.09。他們寫道,住院天數方面沒有觀察到差異,這些研究也都沒有探討音樂對於感染、傷口癒合率或費用等的影響。
  
  根據分析,術前聽音樂與大幅減少疼痛、止痛藥需求與焦慮等有關,其次依序是術中與術後聽音樂。
  
  作者們報告指出,就算是在全身麻醉時,音樂也可減少疼痛,但是,對於疼痛的這個影響在病患有意識時更大。
  
  在被允許自己選擇音樂者中(不論是自己帶來或從醫院提供的音樂中選擇),疼痛情況與止痛藥的使用並無顯著減少。然而,相較於沒有選擇音樂者,選擇音樂的病患,焦慮有些微但不顯著的增加。
  
  作者們寫道,認知活動如聽音樂會影響疼痛的感知與不愉快,使人對疼痛的感覺降低。這或許是可以解釋音樂之影響的可能機轉。另一種可能的機轉是,降低自主神經系統活性,例如降低脈搏與呼吸速率以及降低血壓。
  
  根據他們的結果,作者們相信,已有足夠的研究顯示,進行手術的所有病患都應聽音樂。他們強調,病患應該可以選擇他們想聽的音樂類型,但是這些音樂不可以干擾醫療團隊之間或與病患間的溝通。
  
  澳洲昆士蘭Bond大學的Paul Glasziou博士在相關評論中寫道,音樂是簡單又便宜的介入方式,減少大多數病患在進行手術時的暫時不適。他指出,有類似效果的藥物可能會有極大商機。
  
  Glasziou博士寫道,人們對音樂反應的複雜度會對它的醫療用途帶來一些不確定性。雖然花費低且可改善病患經驗,讓是否使用音樂這個問題似乎是顯而易見。而實際上如何使用則仍不清楚。他指出,播放莫札特或瑪丹娜都可能會使某些人感到平靜、使某些人感到刺激。
  
  他指出,不過,其他這些研究問題不會妨礙目前讓病患作這些理性選擇與執行,當我下次執刀手術時,我會帶一些莫札特音樂和這篇系統回顧資料。
  
  資料來源: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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