Department of Obstetrics and Gynecology, New York Medical College, New York, NY (Dr Weingarten).
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY (Dr Levy).
Am J Obstet Gynecol MFM. 2021 Sep;3(5):100435. doi: 10.1016/j.ajogmf.2021.100435. Epub 2021 Jun 30.
This study aimed to evaluate the effect of music on anxiety in patients undergoing cesarean delivery.
An electronic search of PubMed, CINAHL, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials was performed from inception to November 2020.
Eligibility criteria included all randomized controlled trials of pregnant women undergoing cesarean delivery who were randomized to either the music intervention or control. Studies needed to measure preoperative, intraoperative, or postoperative anxiety via a visual analog scale, State-Trait Anxiety Inventory, or Zung Self-Rating Anxiety Scale, for inclusion. The primary outcome was intraoperative anxiety during cesarean delivery. Secondary outcomes included preoperative and postoperative anxiety, postoperative pain, postoperative opioid requirements, blood pressure, and heart rate.
The methodologic quality of the included studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce a summary of treatment effects in terms of mean difference with 95% confidence intervals. A prespecified subgroup analysis of patients undergoing a scheduled or an unscheduled cesarean delivery was carried out for the main outcomes.
Of the 1296 studies screened, 15 met the inclusion criteria (n=613 music group vs n=748 controls). Three trials (n=217 music group vs n=215 controls) reported on intraoperative anxiety specifically. Among studies using a visual analog scale for anxiety assessment, women in the intervention group had lower intraoperative anxiety levels than the controls (mean difference, -0.54; 95% confidence interval, -0.87 to -0.20; I=0%; n=2 studies). One trial used the State-Trait Anxiety Inventory and 1 trial used the Zung Self-Rating Anxiety Scale for intraoperative anxiety assessment. In both of these studies, music exposure was associated with lower anxiety levels when compared with the controls (State-Trait Anxiety Inventory: mean difference, -2.80; 95% confidence interval, -4.57 to -1.03; Zung Self-Rating Anxiety Scale: mean difference, -4.80; 95% confidence interval, -7.08 to -2.52). In the subgroup analyses, the same relationship persisted when the cesarean delivery was unscheduled and when the music was selected by the patient or by the study team. The effect of music on preoperative and postoperative anxiety varied depending on which anxiety assessment tool was used. Music was also associated with decreased opioid use (mean difference, -0.87; 95% confidence interval, -1.55 to -0.19; I=0%).
In patients undergoing a cesarean delivery, music is associated with decreased intraoperative anxiety.
本研究旨在评估音乐对剖宫产产妇焦虑的影响。
从创建到 2020 年 11 月，对 PubMed、CINAHL、ClinicalTrials.gov 和 Cochrane 对照试验中心注册库进行了电子检索。
纳入标准为所有接受剖宫产的孕妇随机对照试验，随机分为音乐干预组或对照组。研究需要通过视觉模拟评分、状态-特质焦虑量表或 Zung 自评焦虑量表来测量术前、术中或术后焦虑，才能纳入。主要结局为剖宫产术中焦虑。次要结局包括术前和术后焦虑、术后疼痛、术后阿片类药物需求、血压和心率。
使用 Cochrane 干预系统评价手册评估纳入研究的方法学质量。采用 DerSimonian 和 Laird 的随机效应模型进行荟萃分析，以均数差和 95%置信区间的形式总结治疗效果。对主要结局进行了计划性和非计划性剖宫产患者的预设亚组分析。
在筛选的 1296 项研究中，有 15 项符合纳入标准（n=613 音乐组与 n=748 对照组）。有 3 项试验（n=217 音乐组与 n=215 对照组）专门报告了术中焦虑情况。在使用视觉模拟评分评估焦虑的研究中，干预组女性的术中焦虑水平低于对照组（平均差异，-0.54；95%置信区间，-0.87 至-0.20；I=0%；n=2 项研究）。有 1 项试验使用状态-特质焦虑量表，1 项试验使用 Zung 自评焦虑量表评估术中焦虑。在这两项研究中，与对照组相比，音乐暴露与较低的焦虑水平相关（状态-特质焦虑量表：平均差异，-2.80；95%置信区间，-4.57 至-1.03；Zung 自评焦虑量表：平均差异，-4.80；95%置信区间，-7.08 至-2.52）。在亚组分析中，当剖宫产术为非计划性和音乐由患者或研究团队选择时，同样存在这种关系。音乐对术前和术后焦虑的影响取决于使用的焦虑评估工具。音乐也与阿片类药物使用减少相关（平均差异，-0.87；95%置信区间，-1.55 至-0.19；I=0%）。
在接受剖宫产的患者中，音乐与术中焦虑降低有关。
