缺氧性腦病變是臨床醫師相當棘手的難題，其沒有積極有效的治療方法，病人往往會有嚴重的後遺 症，甚至變成植物人，造成醫病關係的緊張，消耗大量社會的成本與資源。音樂治療在台灣的發展 是最近這十幾年來的事，關於音樂治療的相關研究也只有僅僅十幾篇，國外已有報告證實聽覺刺激 (auditory stimulation) 對昏迷病患的預後是有幫助的，但音樂治療對缺氧性腦病變的研究卻很缺乏。
我們的研究即在觀察音樂的介入（特別是熟悉的音樂）對昏迷病患預後的影響，及描述治療過程中 病患行為的改變。
本研究的個案是一名二十三歲的年輕女孩，因不幸發生意外造成手臂血管破裂，在大量出血的情況 之下產生缺血性休克。送來醫院時已呈現昏迷的情況，經急救與緊急手術後生命跡象已呈現穩定，
然而意識依然不清，昏迷指數只有三分，經過數日後昏迷的情況依舊沒有改善，經診斷為缺氧性腦 病變 (hypoxic encephalopathy) 。我們對個案進行十五次為期二個月的「互動性即興式音樂治療」治 療的經過與個案的恢復情形皆有詳細的文字描述與攝影紀錄，並配合多次腦波的檢查。
研究結果發現，隨著治療的進行，病人的意識也逐漸恢復中，病人的昏迷指數與大腦皮質功能皆有 明顯的改善，五次的腦波記錄也可發現，腦波的波形有明顯的進步，治療過程也發現到病患的一些 特殊的行為，當病患聽到熟悉的音樂，會有強烈的情緒反應，會流淚，也會開口跟著唱。
我們的結論為─音樂治療對腦部缺氧病患具有正向的治療效果，我們推論，一個受過音樂訓練的人
，當大腦受到廣泛性的缺氧傷害時，有一些殘存的音樂接收能力被保留下來，藉由熟悉的音樂不斷 地刺激，這些殘存的神經功能被喚醒與組織起來，我們認為藉由音樂的刺激（特別是熟悉的音樂）
，有助於缺氧性腦傷病患大腦皮質功能的恢復，過去如果受過音樂訓練（如彈鋼琴），或長時間接 受音樂刺激（如聆聽音樂）的人，對於音樂治療的效果可能會較一般人要來的好。
但本研究無法確定的是，病人認知功能的恢復，究竟是音樂治療的效果，還是僅僅是自然恢復的過 程 (natural course) 。要解答這個問題，需要未來更大型量化的研究。
音樂治療於缺氧性昏迷病患的個案報告與文獻回 顧
Background and purpose: The brain requires large oxygen consumption and is vulnerable to hypox ic-ischemic injury. Persistent coma after global cerebral ischemia is a serious clinical disorder. Ther e is no optimal treatment for patients to minimize cerebral damage after hypoxic injury. Despite the wide aspects and significance of music therapy applied in clinical trials, little research about music t herapy and hypoxic brain has been done. This study is to determine whether a comatose patient wo uld respond to music stimulation and if there is any significant behavior change.
Method: Our subject is a 23 year-old female patient who suffered from hypoxic encephalopathy wit h severe neurological sequela. She presented with comatose and unresponsiveness. The patient’s fa mily was interviewed to obtain the information regarding her music preferences and previous experi ence with music. Based on the concept of psychotherapy and interactive individual therapy approac h with music, we gave her 15 sessions of music therapy from Oct. 13, 2000 to Dec. 15, 2000. The to tal study period was 7 weeks. (Twice a week and each therapy lasted for 30 minutes). The patient’s participation and responses to the music was documented and recorded in the video.
Result: Relative significant changes demonstrated in serial EEG recordings and improvements of G lasgow Coma Scale (GCS) were presented. During music therapy, we found some significant behav ior change. The most important finding was that the patient would respond to her favorite song by s inging along although she was still unresponsive to other stimulations.
Conclusion: These findings suggest that there is improvement in the conscious level and cognitive f unction of patient with hypoxic brain damage after a period of music therapy. However, the reason i s still unclear. Besides, it is still uncertain that the good outcome of this patient is due to the effect o f music therapy rather than a natural course. It requires further large scale and evidence-based study .
Music Therapy in Hypoxic Coma: A Case Report and Literature Review
