音樂治療於缺氧性昏迷病患的個案報告與文獻回顧
Music Therapy in Hypoxic Coma: A Case Report and
Literature Review
中文摘要
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。
英文摘要
Background and purpose: The brain requires large oxygen consumption and is vulnerable to hypoxic-ischemic injury. Persistent coma after global cerebral
minimize cerebral damage after hypoxic injury. Despite the wide aspects and significance of music therapy applied in clinical trials, little research about music therapy and hypoxic brain has been done. This study is to determine whether a comatose patient would 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 with severe neurological sequela. She presented with comatose and unresponsiveness. The patient’s family was interviewed to obtain the
information regarding her music preferences and previous experience with music. Based on the concept of psychotherapy and interactive individual therapy approach with music, we gave her 15 sessions of music therapy from Oct. 13, 2000 to Dec. 15, 2000. The total 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 Glasgow Coma Scale (GCS) were presented. During music therapy, we found some significant behavior change. The most important finding was that the patient would respond to her favorite song by singing along although she was still unresponsive to other stimulations.
Conclusion: These findings suggest that there is improvement in the conscious level and cognitive function of patient with hypoxic brain damage after a period of music therapy. However, the reason is still unclear. Besides, it is still uncertain that the good outcome of this patient is due to the effect of music therapy rather than a natural course. It requires further large scale and evidence-based study.
