音乐疗法对剖宫产患者术中血流动力学及术后恢复质量的影响

The effect of music therapy on intraoperative hemodynamics and postoperative recovery quality of Cesarean section patients

目的 探讨音乐疗法对剖宫产患者术中血流动力学及术后恢复质量的影响.方法 取择期行剖宫产手术的患者120例为研究对象,随机分为对照组和观察组.对照组患者采用常规干预,观察组患者进入手术室和麻醉恢复室(PACU)后在常规干预基础上播放背景音乐.观察两组患者进入手术室即刻(T0)、麻醉开始时(T1)、手术开始时(T2)、胎儿娩出时(T3)的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)的变化.观察两组患者术前及术后生活质量恢复问卷QoR-40评分、术后不同时点VAS疼痛评分、术后镇痛泵使用情况、术后出血量、开始泌乳时间、肛门排气时间、拔除尿管时间、开始下床活动时间以及头晕、恶心、呕吐等不良反应的发生率.结果 两组患者T0时MAP、HR、RR差异无统计学意义(P>0.05),其余各时点观察组患者MAP、HR、RR均低于对照组(P<0.05).两组患者术前QoR-40总分基线差异无统计学意义(P>0.05),术后24h QoR-40总评分、术后身体舒适度评分、术后疼痛评分、术后心理支持评分、术后情绪状态项目评分、术后自理能力评分,观察组与对照组相比差异具有统计学意义(P<0.05).与对照组比较,观察组患者术后6h、12h VSA评分降低(P<0.05),24h VSA评分差异无统计学意义(P>0.05);术后首次镇痛时间延长,术后24h PCA累积按压次数、有效按压次数减少(P<0.05).与对照组比较,观察组产妇开始泌乳时间、开始下床活动时间、肛门排气时间缩短,头晕、恶心、呕吐发生率降低(P<0.05),术后出血量、拔除尿管时间差异无统计学意义(P>0.05).结论 音乐疗法不仅可以降低剖宫产患者术中血流动力学波动,还可以提高患者的术后恢复质量.

Objective To explore the effect of music therapy on intraoperative hemodynamics and postoperative recovery quality of Cesarean section patients. Methods 120 patients to undergo Cesarean section at arranged date were selected as research subjects and randomly divided into the control group and the observation group. The patients in the control group received routine intervention, while for the patients in the observation group, background music was played on the basis of routine intervention after they entered the operating room(OR) and postanesthesia care unit(PACU). The changes of mean arterial pressure(MAP), heart rate(HR) and respiratory rate(RR) of the two groups of patients immediately after they entered the OR(T0), at the beginning of anesthesia(T1), at the beginning of operation(T2) and at the time of fetal delivery(T3) were observed. The preoperative and postoperative scores of 40-item Quality of Recovery(QoR-40), the Visual Analogue Scale(VAS) pain scores at different postoperative time points, postoperative use of analgesic pump, postoperative hemorrhage volume, lactation start time, anal exhaust time, urinary catheter removal time, time of getting out of bed, and the incidence of dizziness, nausea, vomiting and other adverse reactions(ADRs) of the patients in the two groups were observed. Results There was no statistically significant difference in MAP, HR and RR between the patients of the two groups at T0(P > 0.05), and the MAP, HR and RR of the patients in the observation group were all lower than those in the control group at other time points(P < 0.05). There was no statistically significant difference in preoperative baseline of QoR-40 total scores between the patients in the two groups(P > 0.05). In the total scores of QoR-40 at 24 h after operation, postoperative physical comfort scores, postoperative pain scores, postoperative psychological support scores, postoperative emotional state item scores and postoperative self-care ability scores, the difference between the observation group and the control group was statistically significant(P < 0.05). Compared with those in the control group, the VSA scores of the patients in the observation group decreased at 6 h and 12 h after operation(P < 0.05), and there was no statistically significant difference in VSA scores at 24 h after operation between the two groups(P > 0.05). The first postoperative analgesia time was prolonged, and the cumulative number of PCA compressions and effective number of PCA compressions decreased at 24 h after operation(P < 0.05). Compared with those in the control group, the lactation start time, time of getting out of bed and anal exhaust time of the lying-in women in the observation group were earlier, and the incidence of dizziness, nausea and vomiting decreased(P < 0.05), with no statistically significant difference in postoperative hemorrhage volume and urinary catheter removal time(P > 0.05). Conclusion Music therapy can not only reduce intraoperative hemodynamic fluctuation of Cesarean section patients, but also improve their postoperative recovery quality.