“世界上最放松的音乐”或可代替术前镇静药物

科技工作者之家 2019-08-04

来源:科研圈

一项临床研究发现,在局部麻醉前,让患者聆听音乐可以和镇静类药物一样,达到减轻焦虑的效果。

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《区域麻醉与疼痛医学》(Regional Anesthesia & Pain Medicine)杂志最近发表的一项临床试验研究表明,音乐或许可以取代局部麻醉(外周神经阻滞)前用于镇静神经的常用药。 

局部麻醉是一种在超声波引导下进行的麻醉手术,旨在麻醉身体的特定部位。在实施局麻前,医生会使用镇静剂咪达唑仑(midazolam)减轻患者的焦虑,而音乐似乎也能发挥类似的功效。 

术前焦虑是一种常见现象,它会提高人体内应激激素的水平,继而影响手术后的恢复。

术前焦虑通常使用苯二氮卓类药物治疗,如咪达唑仑。但这些药物有副作用,例如影响患者的呼吸和干扰血流速度,甚至反而会加重患者的情绪紊乱和抵触性情绪。使用这些药物时,还需要经验丰富的临床医生对患者进行持续监测。 

音乐治疗曾被用来降低术前焦虑,但并没有直接与静脉注射咪达唑仑的效果做过比较。因此研究人员想探究,音乐治疗是否可以取代咪达唑仑,让患者在局麻前使用,起到镇静神经的作用。

研究选取了 157 名成年患者,随机分配其中 88 人在进行局麻前的 3 分钟注射 1-2 毫克咪达唑仑,另外 77 人则在局麻前的 3 分钟通过降噪耳机收听马可尼联盟(Marconi Unions’Weightless)的《失重》系列音乐。 

这首歌被认为是世界上最让人放松的音乐之一(点击播放视频,听听这首世界上最让人放松的音乐)。 

两组患者在接受不同神经镇静方法前后的焦虑水平,通过专业的状态-特质焦虑量表-6(State Trait Anxiety Inventory-6,简称STAI-6)进行评分。采用 10 分制评估患者和医生对此的满意度,0 分代表最低满意度。 

结果表明,两组患者术前焦虑水平的变化相似,但音乐组患者的满意度低于咪达唑仑组,研究人员认为这可能是由于患者无法选择他们所听的音乐。而两组试验中医生的满意度并没有差异。 

采用音乐疗法的病人和医生都认为沟通变得困难了,研究者表示这可能是由于使用了降噪耳机,而不是标准化的音乐音量。 

研究者承认,对仅持续 3 分钟的实验结果进行比较,可能时长太短。但之所以选择这个时长,是因为这是咪达唑仑达到最佳效果所需的时间。另外,实验中用来评估满意度的方法并不是一个被认可的有效量表。 

尽管如此,研究人员通过这些结果看到,音乐或许可以成为咪达唑仑的替代品在进行区域神经阻滞前使用,镇静神经。 

研究人员强调说:“我们会进一步研究,不同的音乐类型及其播放方式带来的镇定效果,是否可以弥补这种方式在沟通障碍上的不足。”

论文信息

【标题】Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study

【作者】 Veena Graff, Lu Cai, Ignacio Badiola and Nabil M Elkassabany

【时间】19July2019

【摘要】 Background and objectives Music medicine is a non-pharmacologic intervention that is virtually harm-free, relatively inexpensive and has been shown to significantly decrease preoperative anxiety. In this study we aim to compare the use of music to midazolam as a preoperative anxiolytic prior to the administration of an ultrasound-guided single-injection peripheral nerve block. 

Methods In this randomized controlled study we compared the anxiolytic effects of intravenous midazolam (1–2 mg) with noise-canceling headphone-delivered music medicine. All patients received a preoperative ultrasound-guided single-injection peripheral nerve block indicated for a primary regional anesthetic or postoperative analgesia. 

Results The change in the State Trait Anxiety Inventory-6 (STAI-6) anxiety scores from after to before the procedure were similar in both groups (music group −1.6 (SD 10.7); midazolam group −4.2 (SD 11); p=0.14; mean difference between groups −2.5 (95% CI −5.9 to 0.9), p=0.1). Patient satisfaction scores with their procedure experience were higher in the midazolam group (p=0.01); however, there were no differences in physician satisfaction scores of their procedure experience between groups (p=0.07). Both patient and physician perceptions on difficulties in communication were higher in the music group than in the midazolam group (p=0.005 and p=0.0007, respectively). 

Conclusions Music medicine may be offered as an alternative to midazolam administration prior to peripheral regional anesthesia. However, further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.

【论文链接】 https://rapm.bmj.com/content/44/8/796

来源:keyanquan 科研圈

原文链接:http://mp.weixin.qq.com/s?__biz=MzA5NDkzNjIwMg==&mid=2651683228&idx=2&sn=d2050b1b6ed0d89e728b46c41d6108f3&chksm=8bbed479bcc95d6feef7096f2538c58b7844be35bbd44f45ea2d8b2bdc87b4b84bf8292d9d01&scene=27#wechat_redirect

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