Grafton-Clarke Ciaran, Grace Laura, Harky Amer
School of Medicine, University of Liverpool, Liverpool, UK.
Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2019 May 1;28(5):722-727. doi: 10.1093/icvts/ivy311.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In patients undergoing cardiac surgery, is postoperative music therapy effective in reducing pain and anxiety? Altogether, 153 papers were found using the reported search method, of which 7 represented the best evidence to answer the clinical question. Six of the included studies were randomized trials, with 1 further non-randomized trial. The specific music protocols utilized widely varied, ranging from 1 short session on day 1 postoperatively to multiple sessions per day over a 72-h period. Most therapies involved music of a relaxing type, typically between 50 and 60 dB. All 7 studies reported on pain, with 4 demonstrating significant differences in pain score; however, 3 of these were not associated with reduction in analgesia requirements. Five studies reported on anxiety, with 2 demonstrating a statistically significant improvement in levels of anxiety. These results need to be contextualized by the small number of participants within each study and the heterogeneity in the therapy protocols utilized. The current best available evidence fails to support the benefits of music therapy as an effective non-pharmacological option in reducing pain and anxiety following open-heart surgery. While there is scarce evidence demonstrating efficacy, the current literature contains very small-sample-sized studies in utilizing music therapy protocols which in turn have wide range of variability in terms of duration, frequency, timing in the postoperative period and specific choice of music utilized in each protocol.
根据结构化方案撰写了一篇心脏外科领域的最佳证据主题文章。所探讨的问题是：在接受心脏手术的患者中，术后音乐疗法在减轻疼痛和焦虑方面是否有效？使用报告的检索方法共找到153篇论文，其中7篇代表了回答该临床问题的最佳证据。纳入的研究中有6项为随机试验，另有1项非随机试验。所采用的具体音乐方案差异很大，从术后第1天的1次短疗程到72小时内每天多次疗程不等。大多数疗法采用的是舒缓型音乐，通常在50至60分贝之间。所有7项研究都报告了疼痛情况，其中4项显示疼痛评分有显著差异；然而，其中3项与镇痛需求的减少无关。5项研究报告了焦虑情况，其中2项显示焦虑水平有统计学意义的改善。这些结果需要结合每项研究中参与者数量较少以及所采用治疗方案的异质性来考量。目前可得的最佳证据并不支持音乐疗法作为一种有效的非药物选择在减轻心脏直视手术后疼痛和焦虑方面的益处。虽然几乎没有证据证明其有效性，但当前文献中关于音乐疗法方案的研究样本量非常小，而且这些方案在持续时间、频率、术后时间安排以及每个方案中所使用音乐的具体选择方面存在很大差异。
