音樂介入對骨科病人手術全期焦慮與生理指標之成效

研究背景: 手術治療對病人是種壓力來源，尤其是沒有手術經驗者會有較高的手術焦慮症狀，而手術麻醉方式採區域麻醉特別是骨科手術意識清醒時，更會因為受到工作噪音與環境外在刺激的影響造成焦慮之提升，焦慮會造成病人手術過程生理與心理的不適感，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，雖可用藥物緩解症狀，但藥物易造成術後噁心、嘔吐及術後疼痛指數增加之影響，故更希望透過護理輔助措施能緩解手術焦慮之情形。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，減緩骨科手術病人之焦慮狀況，減少後遺症之發生，提升護理品質參考應用。研究目的: 本研究的目的為探討音樂介入對區域麻醉之骨科病人手術全期焦慮及生理指標之成效。 研究方法: 本研究採實驗性研究方法。於2022年12月至2023年7月，於中部某地區教學醫院首次接受區域麻醉骨科手術的病人64位為研究對象，實驗組32位及對照組32人。實驗組為自選音樂介入時段為：手術前聆聽15分鐘、術中全程聆聽、術後聆聽15分鐘。對照組則給予手術室常規護理。介入前於病房以結構式問卷進行資料收集，測量工具與時段包含:焦慮視覺類比量表(VAS-A)手術前、手術中、手術後測量；生理指標(呼吸、脈搏、血壓)手術前15分鐘後、手術中15、30、60分鐘、手術後15分鐘後測量。 資料分析方法以SPSS for window 25.0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同質性分析，以獨立樣本t檢定、配對樣本t檢定兩組的焦慮指標是否有顯著差異。以廣義估計方程式評估介入後不同時間點2組焦慮指標與介入前的變化與比較進行推論。研究結果： 本研究共有64人為研究對象，實驗組32人及對照組32人，兩組平均年齡為60歲(SD±15)，音樂選擇類型以輕音樂居多，兩組背景皆無顯著差異(p>.05)，顯示其具同質性。實驗組在音樂介入後心理焦慮指標(VAS-A)於術前等待區、手術中、術後恢復室，達顯著性差異(p< .001)。在焦慮生理指標部分，結果顯示音樂介入對於呼吸於手術前、手術中及手術後與手術中舒張壓的成效有顯著差異；心跳、收縮壓全時段皆無顯著差異；舒張壓在等待區與恢復室無顯著差異。透過GEE重複檢定結果顯示呼吸組別與時間效果之交互作用於手術中、手術後效果最好，因此，此研究結果得知音樂介入可以改善區域麻醉之骨科手術病人VAS-A與呼吸焦慮指標之成效。結論與建議： 本研究聆聽音樂有助於減緩骨科手術全期手術焦慮，於手術前等待區介入音樂效果更為顯著，因此建議在術前等候區可以佈置具有音樂場域的環境，提供手術病人等候區之音樂介入護理，以緩解手術病人之焦慮，更提升手術全期護理之功能。本研究結果可作為手術全期運用聆聽音樂減緩手術焦慮之參考。

Background: Surgical treatment is a source of stress for patients, especially those without surgical experience will have higher symptoms of surgical anxiety, and if the patient is conscious during the operation, it will be due to the impact of work noise and external stimuli of the environment to cause anxiety, anxiety will cause the patient's physiological and psychological discomfort during the surgical process, although drugs can be used to alleviate symptoms, it is more desirable to alleviate surgical anxiety through nursing auxiliary measures. Objective: The effects of music interventions on perioperative anxiety and physiological indicators in Orthopedic Patients . Methods: The research was conducted as randomized controlled trial. 64 patients underwent orthopedic in the operating room ward of a teaching hospital in the central part of the country were the research subjects,32 in the experimental group and 32 in the control group. The experimental group listened to music intervened in 15 minutes before the operation, listening during the operation, and 15 minutes after the operation.Prior to the intervention, data collection was conducted in the ward through a structured questionnaire. The assessment tools and intervals included: the Anxiety Visual Analogue Scale (VAS-A) administered prior to surgery, during surgery, and post-surgery; and physiological indicators (respiration, pulse, blood pressure) measured 15 minutes prior to surgery, at 15, 30, 60 minutes during surgery, and 15 minutes following surgery.Data analysis was performed utilizing SPSS for Windows 25.0 software, employing descriptive statistics to delineate the attributes of the variables and Chi-square test for homogeneity analysis, and independent sample t-tests and paired sample t-tests to ascertain if there were significant disparities in anxiety indicators between the two groups. The Generalized Estimating Equation was applied to evaluate and deduce the alterations and comparisons in anxiety indicators at various time points post-intervention versus prior to the intervention.Results: This research involved 64 subjects, divided into an experimental group and a control group of 32 participants each. The average age across both groups was 60 years (SD±15). The choice of music predominantly was light music, and there was no significant difference in the backgrounds of the two groups (p>.05), indicating homogeneity. In the experimental group, significant differences were observed in psychological anxiety indicators (VAS-A) in the preoperative waiting area, during surgery, and in the postoperative recovery room (p< .001). Regarding physiological anxiety indicators, the intervention showed significant differences in respiration before surgery, during surgery, and after surgery, and in diastolic pressure during surgery; however, there were no significant differences in heart rate and systolic pressure at any time point; diastolic pressure showed no significant difference in the waiting area and recovery room. Repeated measures analysis through GEE revealed that the interaction between respiration group and time effect was most effective during and after surgery. Hence, the study concluded that music intervention could significantly improve the efficacy of VAS-A and respiratory anxiety indicators for patients undergoing orthopedic surgery under regional anesthesia.Conclusions: The study suggests that listening to music can effectively reduce surgical anxiety throughout orthopedic procedures, with a notably significant effect when implemented in the preoperative waiting area. Thus, it is recommended to create a musical environment in the preoperative waiting area to offer music intervention nursing for surgical patients, aiming to alleviate their anxiety and enhance the overall quality of nursing care throughout the surgical period. These findings can serve as a reference for utilizing music listening to mitigate surgical anxiety throughout the duration of the surgical process.