音乐治疗联合舒芬太尼术后静脉镇痛对肺癌术后患者血流动力学的影响

Effect of musical therapy combined with sufentanil postoperative intravenous analgesia on hemody- namic changes in patient accepted lung cancer operation

目的观察音乐治疗联合舒芬太尼静脉自控镇痛对肺癌手术后患者血液动力学和镇痛效果的影响。方法择期肺癌手术患者60例，按随机数字表法分为二组（n=30）：音乐治疗组（M组）和对照组（C组）。M组人手术室后，术前接受音乐放松训练15min，术后3、7、15、19h分别进行1h音乐干预。C组在同一时间段不听任何音乐。术后M组与C组均接舒芬太尼静脉自控镇痛泵镇痛。观察并记录术后4、8、12、16、20和24h患者收缩压（SBP）、舒张压（DBP）和心率（HR）变化，并记录术后舒芬太尼用量和视觉模拟评分（visual analogue score，VAS）的数值。结果与C组相比，M组患者术后各时点的SBP、DBP、HR和VAS评分值均显著降低（P〈0．01），且M组的术后自控镇痛装置按压次数[C组（30．96±d．00）次，M组（19．06±3．49）次]和舒芬太尼用量[C组（82．65±6．19）μg，M组（52．68±7．07）μg]明显减少（t=12．39，20．00，P〈0．01）。结论音乐治疗联合舒芬太尼静脉自控镇痛用于肺癌手术后患者能够产生更好的镇痛效果，且能减少舒芬太尼的用量和更有效降低患者血压和心率，缓解患者的焦虑情绪。

Objective To evaluate musical therapy combined with sufentanil postoperative intrave- nous analgesia on hemodynamic changes in patient accepted lung cancer operation. Methods Sixty lung cancer surgery patients （ ASA Ⅰ - Ⅱ grade ） were selected and divided randomly into musical therapy （group M; n = 30） and control （group C; n = 30）. In group M, patients accepted music relaxation training for fifteen minutes before surgery, and music intervention for one hour at 3, 7,15,19 hour after surgery. Whereas, in Group C, patients did not listen to any music during the same period. In the intensive care unit, patients were connected to a patient controlled analgesia （PCA） device. The PCA device （sufentanil 2 ~g/kg, 100 ml saline ） was set to deliver a bolus of 2 ml, with a lockout interval of 10 min and＂ background infusion volume of 0. 5 ml/h. Hemodynamic changes, the visual analog scale （VAS） and consumption of sufentanil were recorded at the 4th, 8th, 12th, 16th, 20th and 24th hour after operation. Results SBP, DBP, HR and VAS of group M were significantly decreased compared to the group C, respectively （ P 〈 0. 05 ）, and significant difference was found in the PCA delivery frequency [ group C （30. 96± 4.00 ） , group M（ 19. 06± 3.49 ）, t = 12. 39, P 〈 0. 01 ] and postoperative sufentanil consumption[ group C （ 82. 65 ±6. 19） μg,group M （52. 68 ±7. 07） μg, t =20. 00, P 〈0. 01 ]. Conclusions Musical therapy combined with sufentanil postoperative intravenous analgesia was able to produce better analgesic effect in the treatment of patient accepted lung cancer operation, which decreased postoperative sufentanil consumption and effectively reduced SBP, DBP and HR, and relieved the patient＇s anxiety.