JAMA:缓解机械通气患者焦虑 音乐有奇效

2013-06-03 姜珊 编译 中国医学论坛报

  美国一项研究表明,与常规护理和佩戴降噪耳机(NCH)相比,以患者为导向的音乐(PDM)护理方式能够较好地缓解因呼吸衰竭接受急性机械通气支持患者的焦虑。该论文5月20日在线发表于《美国医学会杂志》(JAMA)。   该研究纳入373例因呼吸衰竭接受急性机械通气支持的患者。每日对患者焦虑情况进行焦虑VAS评估并对患者镇静剂使用情况进行评分。结果为,PDM组患者在任何时间点的焦虑得分均低于常规护理

  美国一项研究表明,与常规护理和佩戴降噪耳机(NCH)相比,以患者为导向的音乐(PDM)护理方式能够较好地缓解因呼吸衰竭接受急性机械通气支持患者的焦虑。该论文5月20日在线发表于《美国医学会杂志》(JAMA)。

  该研究纳入373例因呼吸衰竭接受急性机械通气支持的患者。每日对患者焦虑情况进行焦虑VAS评估并对患者镇静剂使用情况进行评分。结果为,PDM组患者在任何时间点的焦虑得分均低于常规护理组19.5分。治疗×时间交互分析表明,PDM显著减少镇静药物使用。PDM组较常规护理组镇静药物用量和使用频率分别减少0.18 分/天和0.21 分/天。与NCH组相比,PDM组镇静药物使用频率减少0.18 分/天。


Importance  
Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support.
Objective  
To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients.
Design, Setting, and Patients  
Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days.
Interventions  
Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125).
Main Outcomes and Measures  
Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency).
Results  
Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity.
Conclusions and Relevance  
Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH.
    

作者:姜珊 编译



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