音乐干预对肿瘤患者生理和心理影响的系统评价

The effects of music intervention on physiological and psychological responses of patients with cancer, a Meta-analysis

目的评价音乐干预对肿瘤患者生理和心理状态的影响。方法利用计算机检索中国生物医学文献数据库、中国期刊全文数据库、万方数据知识服务平台、中国维普全文数据库、Cochrane图书馆、Web of Science、PubMed中有关音乐干预对癌症生理和／或心理影响的随机对照试验，由2名评价者独立评价并交叉核对纳入研究质量，采用Cochrane-Handbook5．0手册的质量评价方法评价纳入研究质量，用RevMan5．0软件进行统计分析。结果共纳入29篇随机对照试验，用焦虑自评量表评估音乐干预对肿瘤患者焦虑水平影响的研究共11项，Meta分析结果证实，音乐干预能有效减少肿瘤患者的焦虑水平（WMD=-11．74，95％CI-11．94— -8．53，P〈0．01）；用状态一特质焦虑量表评估音乐干预对肿瘤患者焦虑水平影响的研究共4项，Meta分析结果证实，音乐干预能有效减少肿瘤患者的焦虑水平（WMD=-8．24，95％CI-9．44— -7．04，P〈0．01）；用汉密尔顿焦虑量表评估音乐干预对肿瘤患者焦虑水平影响的研究共2项，Meta分析结果证实，音乐干预能有效减少肿瘤患者的焦虑水平（WMD=-3．37，95％CI-4．93— -1．82，P〈0．01）。用不同的量表评估音乐对肿瘤患者焦虑水平的影响的Meta分析结果均证实，音乐干预可以缓解癌症患者的焦虑情绪。用抑郁自评量表评价比较音乐干预对癌症患者抑郁水平的影响的研究共14项，Meta分析结果证实，音乐干预能有效减轻肿瘤患者的抑郁水平（WMD=-8．12，95％CI-10．75— -5．49，P〈0．01）；用汉密顿抑郁量表评价比较音乐干预对癌症患者抑郁水平的影响的研究共3项，Meta分析结果证实，音乐干预能有效减轻肿瘤患者的抑郁水平（WMD=-3．27，95％CI-6．34— -0．21，P〈0．05）。用不同的量表评估音乐对肿瘤患者抑郁水平的影响的Meta分析结果均证实，音乐干预可以缓解癌症患者的抑郁情绪。用疼痛视觉模拟评分量表评估音乐干预对肿瘤患者影响的研究共9项，Meta分析结果证实，音乐干预能有效减轻肿瘤患者的疼痛水平（WMD=-0．83，95％CI-1．23— -0．44，P〈0．01）。评价标价音乐干预对癌症患者心率的影响的研究共6项，Meta分析结果证实，音乐干预能稳定患者的心率（WMD=-3．38，95％CI-5．13— -1.62，P〈0．05）。评价标价音乐干预对癌症患者收缩压的影响的研究共6项，Meta分析结果证实，音乐干预能稳定患者的收缩压（WMD=-5．34，95％CI-7．95— -2．73，P〈0．01）。结论音乐干预能有效降低肿瘤患者的焦虑、抑郁情绪，降低肿瘤患者对疼痛的敏感性，稳定患者的生理指标，值得在临床实践中探索应用。

Objective To assess the effects of music intervention on physiological and psychological responses of patients with cancer. Methods A computerized search in China Biology Medicine, China National Knowledge Infrastructure,Wanfang data ,VIP, Cochrane library, Web of Science and PubMed was performed for relevant randomized control trials comparing the effects of music intervention on physiological and psychological responses of patients with cancer. The quality of studies was critically appraised and data were extracted by two reviewers independently. The Cochrane- Handbook5.0 was used to evaluate the quality of studies. Data was analyzed by RevMan5.0 software. Results A total of 29 randomized control trials were involved. Eleven studies about the effects of music intervention on anxiety level of patients with cancer were assessed with Self-rating Anxiety Scale,Meta analysis confirmed that music intervention could effectively reduce the anxiety level of patients with cancer （WMD=- 11.74, 95% CI - 11.94-- 8.53, P〈0.01）. Four studies about the effects of music intervention on anxiety level of patients with cancer were assessed with state-trait anxiety inventory,Meta analysis confirmed that music intervention could effectively reduce the anxiety level of patients with cancer （WMD=-8.24, 95%CI-9.44--7.04, P〈0.01）. Meta-analysis showed that music intervention was able to relieve anxiety, depression, pain of patients with cancer. Two studies about the effects of music intervention on anxiety level of patients with cancer were assessed with Hamilton Anxiety Scale,Meta analysis confirmed that music intervention could effectively reduce the anxiety level of patients with cancer （WMD=-3.37, 95%CI-4.93--1.82, P〈0.01）. Fourteen studies about the effects of music intervention on depression level of patients with cancer were assessed with Self-rating Depression Scale,Meta analysis confirmed that music intervention could effectively reduce the depression level of patients with cancer （WMD=-8.12, 95% CI-10.75-- 5.49, P〈0.01）. Three studies about the effects of music intervention on depression level of patients with cancer were assessed with Hamilton Depression Scale,Meta analysis confirmed that music intervention could effectively reduce the depression level of patients with cancer （WMD=-3.27, 95%CI -6.34--0.21, P=0.04）. A total of 9 studies were conducted to evaluate the effects of music intervention on patients with the pain Visual Analogue Scale,Meta analysis confirmed that music intervention could effectively reduce the pain level of patients with cancer （WMD=-0.83, 95%CI- 1.23-- 0.44, P〈0.01）.A total of 6 studies were conducted to evaluate the effects of music intervention on heart rate in cancer patients,Meta analysis confirmed that music intervention could stabilize the heart rate of patients （WMD=-3.38, 95%C1-5.13--1.62, P=0.002）.A total of 6 studies were conducted to evaluate the effects of music intervention on systolic blood pressure in patients with cancer,the results of Meta analysis showed that music intervention could stabilize the systolic pressure in patients （WMD=-5.34, 95%CI -7.95--2.73, P〈0.01）. Conclusions Music intervention has effects on reducing potentially harmful psychological responses of patients with cancer,which deserve to be explored and spread in clinical practice.