音乐干预增加早产儿安静睡眠时间的随机对照试验

Musical intervention increases quiet sleep time of preterm infants: A randomized controlled trial

目的观察音乐干预后早产儿安静睡眠周期(QSC)和脑电特征的变化。方法单中心RCT。以复旦大学附属儿科医院(我院)新生儿科收治入院的32周≤胎龄<36周早产儿为研究对象,随机分为干预组和对照组。对照组生命体征平稳下常规护理;干预组在对照组干预的基础上予勃拉姆斯摇篮曲,音量40~50分贝,每24 h播放1次,每次持续6 h;两组干预时间均为7 d,且在之后的48 h内行6 h的脑电图监测。主要观察指标为QSC特征,包括QSC的平均时间、总时间、出现次数、中断频率、平均间隔;次要观察指标为舒适度评价(COMFORTneo量表)和振幅整合脑电(aEEG)评分(Burdjalov评分法)。结果2018至2019年的13个月中112例早产儿入组,干预组和对照组各56例完成研究。2组的基线指标差异均无统计学意义。①QSC特征:干预组较对照组QSC平均时间增加0.17 h、出现的总时间增加0.52 h、中断次数少2次,差异均有统计学意义。②舒适度评分:干预组较对照组COMFORTneo量表总分高1.9分、警觉性评分高0.8分,差异均有统计学意义。③aEEG评分:干预组较对照组睡眠觉醒周期评分高0.7分、波谱带宽评分高0.7分、总体评分高1.4分,差异均有统计学意义。④QSC平均时间、总时间、舒适度评分总分和aEEG评分总分均随着胎龄的增大而增加,与胎龄呈正相关。结论音乐干预可对早产儿QSC和脑电活动产生影响,包括增加QSC单次时间、总时间,减少QSC中断次数,改善早产儿舒适度评分与脑电评分。

Objective:The influence of music on the sleep cycle and brain electrical activity of preterm infants is still inconclusive.This article aims to observe the changes in the quiet sleep cycle(QSC)and EEG characteristics of preterm infants after music intervention.Methods:This study was a single-center randomized controlled trial.Preterm infants admitted to the Neonatal Department of Children's Hospital of Fudan University at 32 weeks≤gestational age<36 weeks were divided into a musical intervention group(intervention group)and a control group in the ratio of 1∶1 using a randomized numerical table.The intervention group was given Brahms lullabies at an average volume of 40-50 dB,played once every 24 h for 6 h.The intervention period was 1 week.The control group was given no musical intervention,and the nursing measures were the same as the intervention group.EEG monitoring was carried out for 6 h within 48 h after completion of the intervention in rhe two groups.The primary observation was the characteristics of the quiet sleep cycle,including mean QSC time,total QSC time,QSC frequency,QSC interruption frequency,and mean QSC interval.The secondary observation was the comfort score(COMFORTneo scale)and the amplitude integrated EEG outcome score(Burdjalov's method).Results:A total of 112 subjects completed enrollment from June 1,2018 to June 30,2019,with 56 in the intervention and 56 in the control group.The differences in baseline data between the two groups were not statistically significant.In terms of QSC characteristics,the mean QSC duration in the intervention group increased by 0.17 h(P=0.015),the total time of QSC occurrence during EEG monitoring increased by 0.52 h(P=0.033),and the number of QSC interruptions was three times fewer than that in the control group(P=0.003).For comfort score,the total scale score in the intervention group was 1.9 points higher(P=0.031)and the alertness score was 0.8 points higher(P=0.042)than those in the control group.For aEEG score,the sleep-wake cycle score was 0.7 points higher(P=0.043),the spectral bandwidth score was 0.7 points higher(P=0.019),and the overall score was 1.4 points higher(P=0.047)in the intervention group than those in the control group.Mean QSC time,total QSC time,total comfort score,and total aEEG score all increased with gestational age.There were positive correlations between gestational age and mean QSC time,total QSC time,comfort scores,and aEEG scores.Conclusion:Music intervention can affect the quiet sleep cycle and EEG activity of preterm infants,including increasing the time of single QSC,total QSC time,reducing the number of QSC interruptions,and actively improving the comfort score and EEG characteristics of preterm infants.