音乐治疗对严重烧伤患者睡眠质量和机体炎症因子的影响

Effect of music therapy in severe burn injury with sleep disorders and body's inflammatory cytokine

目的观察音乐治疗对严重烧伤患者睡眠障碍的治疗作用及对炎症因子的影响。方法以2009年8月至2014年11月哈尔滨市第五医院烧伤科收治的120例严重烧伤患者为研究对象,烧烫伤深度均为深Ⅱ度、Ⅲ度,烧烫伤面积为(68.5±15.0)%总体表面积(TBSA)。患者按随机数字表法分为治疗组(n=60)和对照组(n=60)。对照组采用烧伤科传统治疗方法即外用烧伤药膏均匀涂布创面(1次/8 h)、抗生素预防感染等治疗8周。治疗组在对照组传统治疗方法基础上,给患者施行音乐治疗即播放舒缓音乐的同时进行语言诱导以使患者进入放松状态,每次30 min,于晚上睡觉前实施,每周5次,共治疗8周。于治疗前及治疗后1、4、8周采用匹兹堡睡眠质量指数量表(PSQI)评估两组患者睡眠质量,应用酶联免疫吸附(ELISA)测定两组患者血清肿瘤坏死因子α(TNF-α)和白细胞介素-6(IL-6)水平。PSQI评分及炎症因子水平采用t检验进行统计学分析。结果治疗前,两组严重烧伤患者的PSQI评分、血清TNF-α和IL-6水平比较,差异均无统计学意义(P值均大于0.05);治疗1周后,治疗组较对照组PSQI评分低,血清TNF-α和IL-6水平下降,两组比较差异有统计学意义(P值均小于0.05)。至治疗第8周,治疗组患者PSQI评分为(8.71±1.97)分,血清TNF-α和IL-6水平分别为(43.1±11.9)ng/L和(347.2±12.9)ng/L,均明显低于对照组(9.75±2.31)分、(49.5±11.5)ng/L和(419.3±13.5)ng/L,差异均具有统计学意义(t=2.654、7.325、13.027,P=0.003、0.007、0.001)。结论严重烧伤患者辅助音乐治疗可以明显改善睡眠质量,降低炎症因子水平,改善患者机体的炎症反应状态。

Objective To analyze the effect of music therapy in severe burn patients with sleep disorders and body' s inflammatory cytokine. Methods One hundred and twenty burned patients were involved in this study,the depth of burn were deep degree Ⅱ,Ⅲ degree,the burn area was( 68. 5 ±15. 0) % total body surface are( TBSA). They were admitted at the department of burns,the Fifth Hospital of Harbin during August in 2009 to November in 2014,they were divided into treatment group( n = 60) and control group( n = 60) according to the random number table. The control group only received topical drug dressing and antibiotics to prevent infection. The treatment group based on the control group,they were all received soothing music and language induction which enable the patients into a relaxed state,30 min each time,5 times a week,they were all received music therapy for 8 weeks after burn therapy. Methods of pittsburgh sleep quality index( PSQI) consist of the quality of sleep compared between two groups before therapy and 1、4、8 weeks after therapy. The serum inflammatory TNF-α、IL-6 were detected by enzyme liked immunosorbent assay( ELISA). Data were processed with t test. Results Before therapy,the PSQI score and the inflammatory of TNF-α、IL-6 in the two groups,the difference was no statistically significant. After one week of therapy,the PSQI score and the inflammatory of TNF-α、IL-6 in the two groups,the difference was statistically significant. Music therapy after eight weeks,the PSQI score and the inflammatory of TNF-α、IL-6 in treatment group were( 8. 71 ± 1. 97),( 43. 1 ± 11. 9) pg /m L,( 347. 2 ± 12. 9) pg /m L,which were lower than the control group( 9. 75 ± 2. 31),( 49. 5 ± 11. 5) pg / m L,( 419. 3 ± 13. 5) pg / m L,the difference was statistically significant( t = 2. 654,7. 325,13. 027,P = 0. 003,0. 007,0. 001). Conclusions Music therapy could effectively reduce the sleep disorder and body's inflammatory cytokine with severe burn injury patients,and the inflammatory respond in these patients was improved significantly.