围术期音乐治疗对椎管内麻醉下妇科手术病人术中镇静的影响

Effects of perioperative music on sedation in patients undergoing gynecological surgery under intravertebral anesthesia

目的观察围术期音乐对椎管内麻醉下妇科手术病人术中异丙酚靶控输注镇静的影响。方法110例于椎管内麻醉下行全子宫切除术者,随机分两组。音乐组于术前选定音乐调好音量;从术前6 min至术毕听音乐。对照组只戴耳机,不听音乐。所有病人切皮前5 min给予1μg／kg芬太尼和0．5 mg／kg异丙酚静注,手术开始时行靶控输注,初始靶控浓度为1．2μg／ml,此后每10 min按0．2μg／ml梯度调整,直至镇静评分达OAA／S 3分。记录镇静诱导时间、术中异丙酚用量和镇静满意度。结果(1)镇静诱导时间:音乐组(12 min±12 min)明显短于对照组(18 min±12 min)(P <0．01);(2)异丙酚靶控浓度和用量:音乐组(1．6μg／ml±0．3μg/ml、171 mg±98 mg)明显低于对照组(2．4μg/ml±0．4μg／ml、251 mg±92 mg)(均P<0．01);(3)镇静满意度:音乐组(9．7±0．6)明显高于对照组(8．1±1．0)(P<0．01)。结论围术期音乐对椎管内麻醉下妇科手术病人有良好的术中镇静作用。

Objective To investigate the effects of music on propofol target-controlled infusion （TCI） in patients during gynecological surgery under intravertebral anesthesia. Methods One hundred and ten patients scheduled for gynecological surgery under intravertebral anesthesia were randomly assigned to two groups. The music group patients were asked to determine music and its sound volume preperatively, which were played from 6 rain before the surgery to the end. A loading dose of 1μg/kg fentanly and 0.5 mg/kg propofol was administered intravenously to all the patients 5 min prior to operation. At the beginning of surgery, the TCI of propofol was initiated at propofol target controlled concentration of 2 μg/ml, which was modulated at a grade of 0.2 μg/ml every 10 min to maintain an observer＇s assessment of alertness/sedation （OAK/S） score of 3 intraoperatively. Induction time of sedation, intraoperative amount of propofol and patient＇s satisfaction of sedation were assessed. Results （ 1 ） The music group patients had a significant shorter induction time of sedation （ 12 min ± 12 min） than the controls （ 18 min ± 12 min） （ P 〈 0.01 ）. （2） The music group patients had a significant less propofol target-controlled concentration （ 1.6 μg/ml ± 0.3 μg/ml） and delivers （171 mg ±98 mg） than the controls （2.4 μg/ml ±0.4 μg/ml and 251 mg± 92 mg） （both P 〈0.01 ）. （3） The music group patients had a significant higher satisfaction （9.7±0.6） than the controls （8. 1 ± 1.0） （P 〈 0. 01 ）. Conclusion Music has perfect sedative effects in patients undergoing gynecological surgery under intravertebral anesthesia.