心胸外科術後使用音樂介入對於肺擴張運動之效應

The effect of music intervention on lung expansion after cardiothoracic surgery.

陳冠毅(Guan-Yi Chen)

指導教授 ： 郭藍遠

高雄醫學大學/醫學院/運動醫學系碩士在職專班/碩士(2020年)

摘要

背景：病人在接受心胸外科手術之前，雖有得到良好的衛教即可正確執行，但術後往往因疼痛或焦慮、緊張導致不配合。術後以音樂介入能降低術後病人之疼痛及焦慮進而願意接受肺擴張運動或其他治療。
目的：本研究欲探討接受心胸外科手術病人術後以音樂介入執行肺擴張運動後，尖峰吐氣流速（peak expiratory flow rate, PEFR）、肺活量（ vital capacity, VC ） 與最大吸/ 吐氣壓力（ maximal inspiratory/expiratory pressure, MIP/MEP）短期內的效益，同時評估視覺疼痛量表（VAS）、STAI 焦慮量表與生命徵象以確保病人安全。
方法：將受試者隨機分派為音樂組（music）與控制組（control），兩組均戴上降噪耳機並執行間歇性正壓通氣（intermittent positive pressure breathing, IPPB）作為肺擴張運動，音樂組播放自然環境音樂，控制組無音樂播放，連續介入七天。並在術前與治療後第七天評估焦慮量表。
結果：本案共收錄18 位受試者（年齡為60.78 ± 10.90 歲，BMI 26.58 ± 3.67 Kg/m2，術前VC25.79 ± 8.31 mL/Kg，術前MIP 64.83 ± 22.79 cmH2O，術前MEP 80.17 ± 30.63 cmH2O，術前PEFR 374.44 ± 123.82 L/min）完成本試驗。最大吸氣壓力與最大吐氣壓力在組別上有明顯差異（p < .05），整體的交互作用下最大吐氣壓力有統計上的意義（p < .001），且控制組優於音樂組。疼痛程度則以音樂組優於控制組（p = .046），但受時間的整體交互作用無顯著差異。整個實驗無其他副作用產生，焦慮程度術前術後的改變量兩組之間也沒有顯著差異（p > .05）。
結論：對於心胸外科術後病人使用自然音樂聆聽，雖控制組之最大吸氣與最大吐氣壓力能較快回復，但在治療後的第七天，兩組整體的回復程度是相近的，且自然音樂聆聽能降低疼痛感也可降低術後焦慮狀態，血氧飽和度會更好。

關鍵字

音樂 ； 肺擴張運動 ； 心胸外科手術

並列摘要

Background: Appropriate preoperative instructions before a cardiothoracic surgery may help patients performed lung expansion therapy correctly. While postoperative pain, anxiety, or nervousness often lead to patients' noncompliance. Music interventions can reduce postoperative pain and anxiety so that patients are willing to do lung expansion exercises or other treatments.
Purpose: Investigate that after music interventions, the short-term benefits of the peak expiratory flow rate (PEFR), vital capacity (VC), and maximal inspiratory/expiratory pressure (MIP/MEP) of patients who undergo a cardiothoracic surgery. At the same time, assess the Visual Analogue Scale (VAS), the State-Trait Anxiety Inventory (STAI), and vital signs to ensure the patient's safety.
Methods: Subjects were randomly assigned to either a music intervention group or a control group. Both groups performed intermittent positive pressure breathing (IPPB) for lung expansion with noise-canceling headphones. The music intervention group was exposed to nature music, while the control group provided headphones without music, and the experiment lasted for 7 days. The anxiety scale was assessed before surgery and on the seventh day after treatment.
Results: A total of 18 subjects (age 60.78 ± 10.90 years old, BMI 26.58 ± 3.67 Kg/m2, preoperative VC 25.79 ± 8.31 mL/Kg, MIP 64.83 ± 22.79 cmH2O, MEP 80.17 ± 30.63 cmH2O, and the PEFR 374.44 ± 123.82 L/min) completed the test. Patients' performance of MIP/MEP has a statistical significance (p < .05) in group, and MEP has a statistical significance in all time-interaction (p < .001), and the control group was better than the music group. In contrast, less degree of pain was found among the music group than the control group (p = .046), but there was no significant difference in all time-interaction. No side effects were found in the whole experiment, and there was no significant difference in decreasing anxiety between the two groups (p > .05).
Conclusion: For patients undergoing cardiothoracic surgery using natural music listening, although the MIP and MEP of the control group recovered quickly, on the seventh day after treatment, the overall recovery degree of the two groups was similar. With listening to natural music, it could reduce pain and postoperative anxiety, and the oxygenation would be better.

並列關鍵字

music ； lung expansion ； cardiothoracic surgery

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