精油或音樂介入對焦慮指標之影響─以使用呼吸器病人為例

研究目的：焦慮對病人而言，可能會造成負面之影響，包括延遲傷口之癒合、潛在呼吸道感染及免疫功能改變等的問題進而延長住院，增加死亡率等。本研究旨在討音樂介入或精油按摩對呼吸器病人焦慮指標─主觀焦慮程度、生理指標及血清皮質醇之影響。期望本研究結果能提供更具實證之依據，以提供臨床醫護人員能以最安全簡單之方法，減緩使用呼吸器病人之焦慮狀況，減少後遺症之發生，提升護理品質。研究方法及資料：本研究為隨機對照試驗，以加護病房使用呼吸器病人為樣本，隨機分配至三組，分別為音樂介入組、精油組及對照組。音樂介入組聽30分鐘自選音樂，精油組為精油塗抹及按摩背部5分鐘，對照組為給予無音樂之耳機30分鐘，介入前以結構性問卷、生理徵象及血清皮質醇基礎，介入30分鐘後再次測量結構性問卷及血清皮質醇，期間則每10分鐘監測生理徵象連續60分鐘。結構式問卷，包括基本資料、中文版焦慮情境量表、視覺類比量表。資料分析方法以SPSS for window 17.0套裝軟體進行，採描述性統計呈現變項資料的屬性及卡方檢定進行三組同質性分析，以ANOVA檢定三組的平均數是否有顯著差異，事後比較則以Bonferroni法校正。以Difference in difference，評估介入後特定時間點三組焦慮量表、生理指標及血清皮質醇與介入前升降的變化與比較進行推論。研究結果：在主觀焦慮指標部分─音樂及精油按摩組介入30分鐘後在視覺類比量表及焦慮情境量表有顯著之差異；在生理指標部分─音樂的介入對於心跳、血壓等反應在20分鐘後即開始產生，但其介入到40分鐘後可能疲乏，其效果並無顯著差異。精油按摩對於心跳、血壓的指標在介入30〜40分鐘後才產生，但介入後60分鐘仍具有效果。三組對於呼吸速率的影響並無顯著差異；在血清皮質醇部分─在音樂介入組有顯著差異，精油按摩組則無顯著差異。結論與建議：音樂介入和精油按摩可以減輕使用呼吸器病人之焦慮程度，而停止介入後其效果仍可持續長達30分鐘。音樂與精油按摩是安全性高且具便利性的輔助療法，建議加護病房之臨床工作人員可以同時使用音樂及精油介入替代使用鎮靜劑等藥物減緩病人之焦慮，增進病人之舒適進而提升護理品質。

關鍵字

焦慮；音樂；精油按摩；呼吸器患者

並列摘要

Objective：Anxiety is a common problem for patients who are mechanically ventilated. High anxiety may cause negative effects, including delayed wound healing, potential respiratory infections and changes in immune functions. These adverse events often lead to prolonged dependence on the ventilator and mortality. The purpose of this study was to evaluate the effect of music therapy and that of aromatherapy on anxiety reduction using subjective response, physiological indicators (including serum cortisol) for patients in intensive care unit (ICU) who were undergoing mechanical ventilation. Methods and Materials：This study was a randomized controlled trial. Patients in an ICU for more than 24 hours were randomly assigned to a music intervention group, essential oil group or Control group. Patients in the Music intervention were given music therapy; patients in the essential oil group received lavender essential oil massage on his/her back for 5 minutes; patients in the Control group wore noise-free headphones. Anxiety was measured using the Chinese version of the Stage-Trait Anxiety Inventory (C-STAI), the Visual Analogue Scale for Anxiety (VAS-A) and serum cortisol at baseline, post-test, and 30-minute follow-up. Other physiological indicators of heart rate, breathing rate, and blood pressure were measured every 10 minutes from baseline continued 60-minute follow-up. Data were analyzed by descriptive statistics, Chi-square tests, ANOVA and Difference in difference. All the statistical analyses were done by SPSS for windows 17.0. Results：There was a significant difference between the C-STAI and VAS-A in the subjective anxiety index section - 30 minutes after the intervention of music and essential oils. In the part of the physiological indicators - the effects of music therapy were shown for heartbeat and systolic blood pressure in 20 minutes after intervention; however, the effects were faded after 40 minutes after intervention. The effects of aromatherapy on heart rate and systolic blood pressure revealed until 30-40 minutes after intervention, and lasted for 60 minutes or more. There was no difference in the effects of the three groups on respiration rate. Moreover, serum cortisol was significantly lower in the music intervention group as compared with the Control group. Conclusion and Suggestion：Both music therapy and aromatherapy were effective for ICU patients who underwent a ventilator. The effects of music intervention were prominent than that of aromatherapy; both interventions sustained the effects for at least 30 minutes. Music therapy and aromatherapy are adjuvant safe therapy and convenience. It is recommended that clinician staff in the ICU can use music therapy or aromatherapy instead of medication to manage anxiety for patients receiving ventilation.