围术期音乐干预对于椎管内麻醉骨科清醒患者的研究现状与展望

Current Status and Future Perspectives of Perioperative Music Intervention in Awake Orthopedic Patients Undergoing Spinal Anesthesia

摘要: 椎管内麻醉是骨科手术的常用麻醉方式，患者术中保持清醒，手术室环境噪音以及对于手术的担忧可能引发焦虑和应激反应。音乐干预作为一种无创、安全、低成本的辅助手段，近年来在该领域的应用研究日益增多。本文汇总近年围术期音乐疗法相关Meta分析、骨科椎管内麻醉随机对照研究，从神经生物学机制、临床效应(焦虑、疼痛、镇静需求、血流动力学)及潜在风险三个维度梳理研究现状。现有证据表明，术中音乐干预可显著减轻患者焦虑、减少镇静药物需求、提高满意度，其效应可能与音乐调节“疼痛矩阵”及下丘脑–垂体–肾上腺轴功能等调节机制有关。然而，音乐类型选择、干预时机、音量控制及对医疗团队的潜在干扰等问题尚缺乏标准化方案，临床推广仍需进一步高质量研究支持。

Abstract: Neuraxial anesthesia is commonly used in orthopedic surgery. Because patients remain conscious during surgery, operating-room noise and concerns about the procedure may provoke anxiety and stress responses. Music intervention is a noninvasive, safe, and low-cost adjunct whose perioperative application has received increasing attention. This review summarizes recent meta-analyses and randomized controlled studies of music therapy in orthopedic patients under neuraxial anesthesia, addressing neurobiological mechanisms, clinical effects on anxiety, pain, sedative requirements, and hemodynamics, as well as potential risks. Current evidence suggests that intraoperative music can reduce anxiety and sedative requirements and improve patient satisfaction. These effects may involve top-down modulation of the pain matrix and regulation of the hypothalamic-pituitary-adrenal axis. However, heterogeneity in music selection, timing, delivery, and outcome assessment limits comparability across studies. Future work should establish standardized and individualized protocols and evaluate their clinical and economic value.