Effects of Traditional Chinese Medicine Five-element Music Combined with Acupoint Application on Perioperative Sleep Quality in Patients Undergoing Joint Replacement Surgery

Gu Lidan (谷立丹), Wang Qiuju (王秋菊)

Second Special-needed Ward, Beijing Jishuitan Hospital, Beijing 100035, China

ABSTRACT

OBJECTIVE: To explore the effects of traditional Chinese medicine (TCM) five-element music combined with acupoint application on perioperative sleep quality in patients undergoing joint replacement surgery. METHODS: In this study, a total of 122 patients with joint replacement surgery in Beijing Jishuitan Hospital were targeted from 2015 to 2018. All patients were grouped by random number table method. Among them, 61 patients with routine nursing were included in the control group. On this basis, the other 61 patients with acupoint application and TCM five-element music therapy were included as the observation group. 2 weeks later, the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality in all patients. The sleep improvement of the 2 groups was evaluated, and the patient was assessed for anxiety and depression, and the curative efficacy was evaluated. RESULTS: After 2 weeks of nursing, the PSQI of the patients improved significantly. The PSQI of the observation group was only 6.6 ± 2.4, and the control group decreased to 9.9 ± 2.7. The observation group was better than the control group, and the difference was statistically significant (P < 0.05). Comparing the 2 groups, the anxiety score of the observation group decreased to 4.8 ± 1.6,which was significantly lower than that of 6.9 ± 2.2 in the control group. The depression score of the observation group decreased to 4.6 ± 1.3, which was significantly lower than that of 6.8 ± 2.3 in the control group. In the control group, the negative emotion scores after nursing were better than those before nursing, and the difference was statistically significant (P < 0.05). Comparing the 2 groups, the effective rate of sleep improvement in the observation group was 96.6%, and the cure rate was as high as 49.1%. The control group was 82.0%, and the cure rate was 18.0%. The observation group was better than the control group, and the difference was statistically significant(P < 0.05). CONCLUSION: The combination of TCM five-element music with acupoint application can improve the perioperative sleep quality of patients undergoing joint replacement surgery, and it can help patients to relieve negative emotions. It is worth promoting.

KEYWORDS: Traditional Chinese medicine five-element music; Acupoint application; Joint replacement surgery;Sleep quality

The number of patients with femoral joint disease in China is nearly 40 million. With the increasing rate of aging population and the improvement of the national medical security level, the number of patients undergoing joint arthroplasty has gradually increased.Joint replacement surgery can effectively eliminate joint pain, restore joint function and improve the quality of life of patients. Studies have shown that postoperative care in patients with arthroplasty has a direct impact on the patient's postoperative outcome[1]. Patients with perioperative joint replacement are often accompanied by difficulty in falling asleep and insomnia. Sleep disorder can cause a series of physical and psychological problems,affecting the normal life of the patient, endangering the patient's health, and adversely affecting the patient's postoperative recovery[2]. Related studies have shown that insomnia and sleep quality problems are important risk factors for mental illness such as depression and anxiety in patients[3]. Studies abroad have shown that clinical music therapy is a mature and well-established nursing method that has been promoted and used clinically. By playing relaxing and soothing music for patients, it can effectively help patients relax and relieve stress and anxiety[4].

The traditional Chinese medicine (TCM) fiveelement music nursing practiced in China is based on the traditional Chinese five-tone (Gong, Shang, Jue, Zhi, Yu),which corresponds to the human spleen, lung, liver, heart and kidney[5]. Clinical five-element music care analyzes the cause and symptomatic conditioning according to the specific symptoms of the patient. Acupoint application is a TCM nursing therapy. For patients with severe symptoms of insomnia during perioperative period, select Shenmen(HT 7) and Anmian (EX-HN22) for conditioning. This study analyzed the effects of TCM five-element music combined with acupoint application on perioperative sleep quality in patients undergoing joint replacement surgery.

MATERIALS AND METHODS

General information

A total of 122 patients with joint replacement surgery who were treated in Beijing Jishuitan Hospital from 2015 to 2018 were selected as the study subjects.The random number table method was used to group,including 61 cases in the observation group, 36 males and 25 females with an average age of (52.2 ± 5.2) years old, and the age was 36-71 years old; and 61 cases of the control group, 35 males and females with an average age of (51.8 ± 6.3) years old and the age was 35-72 years old. The age, sex, and duration of the 2 groups were comparable. Inclusion criteria: ① All patients had no central system disease; ② All patients volunteered to participate in the study. Exclusion criteria: ① The patient had a history of surgery. ② The patient was unwilling to cooperate in the investigation.

Methods

The control group was given health education and routine nursing care. The specific nursing programs were as follows: ① Develop a systematic health education plan, and adopt individualized education, group lectures,patient associations, and health education manuals to provide targeted education for patients with different medical conditions and different educational levels through PPT. Explain knowledge about drugs, diet, selfmanagement, and psychological adjustment. And through the QQ group, WeChat group, special consultation phone,etc. to answer patients' questions. ② For postoperative patients, there were many negative emotions such as anxiety and depression, and psychological care was needed. The nursing staff should carry out active and appropriate communication with them, and timely discover the negative emotions of the patients. They should psychologically guide the patients with positive and enthusiastic attitudes and listen to the patients'complaints, so that the patients would feel respected and their bad emotions would be eliminated. ③ There was pain after surgery and the appetite was affected. In the early stage patients should adopt a light diet and pay attention to eating less and eating more meals. In order to promote the healing of fracture, the high-protein and high-energy food should be appropriately added in the later stage to supplement nutrition. ④ Assist the patient in functional exercise for the patient's condition. Early postoperative patients were known to undergo muscle contraction training to promote swelling going down and prevent thrombosis. In the formation of callus, the patient was instructed to strengthen joint function training and prevent joint adhesion.

The observation group was treated with acupoint application therapy and TCM five-element music nursing on basis of routine nursing. The TCM five-element music nursing was based on the traditional Chinese fivetone (Gong, Shang, Jue, Zhi, Yu). For the perioperative clinical features of patients undergoing replacement surgery, Gong, Zhi, and Jue were used for music therapy,which corresponded to the spleen, heart and liver to help patients sleep and calm down. The patient was treated 2 times of TCM five-element music care in the morning and evening. The time of each treatment was controlled at 30 minutes. The Gong, Zhi and Jue were played for 10 minutes, and the connections were smooth. At the same time, all patients were treated with acupoint application.In this study, Shenmen (HT 7) and Anmian (EX-HN22)of the patient were selected and applied daily with Manji Magnetic Stickers.

Observation index

① The patient's sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). ② Using a 10 cm measurement line, the patient could self-evaluate his anxiety and depression. ③ Evaluate the patient's curative effect. Cured meant that the patient's insomnia disappeared completely and the sleep quality was good.Significantly effective meant that the patient's insomnia improved substantially, and the sleep time increased by at least 3 h, and the sleep quality improved. Effective meant that the patient's insomnia was slightly improved,but increased less than 3 h. Invalid meant that the patient had no improvement in insomnia, or the insomnia was aggravated.

Statistical methods

The data was analyzed and processed using statistical software SPSS 17.0. Measurement data was tested by t-test. The counting data was tested by χ2, and P < 0.05 indicated that the difference was significant.

RESULTS

Comparison of PSQI index before and after nursing in 2 groups of patients

After 2 weeks of nursing, the PSQI index of the patients improved significantly. The PSQI index of the observation group was only 6.6 ± 2.4, and the control group decreased to 9.9 ± 2.7. The observation group was better than the control group, and the difference was statistically significant (P < 0.05). See Table 1.

Table 1. Comparison of PSQI Index between the 2 groups before and after Nursing Care

Table 1. Comparison of PSQI Index between the 2 groups before and after Nursing Care

Observation group 61 14.9±3.1 6.6±2.4 2.388 0.022 Control group 61 15.1± 2.8 9.9±2.7 2.011 0.045 t—1.7262.683——P—0.0810.007——

Comparison of negative emotions between the 2 groups

Comparing the 2 groups, the anxiety score of the observation group decreased to 4.8 ± 1.6, which was significantly lower than the control group score of 6.9 ± 2.2.The depression score of the observation group decreased to 4.6 ± 1.3, which was significantly lower than the control group score of 6.8 ± 2.3. In the control group, the negative emotion scores after nursing were better than those before nursing, and the difference was statisticallysignificant (P < 0.05). See Table 2.

Table 2. Comparison of curative effects between the 2 groups (n/%)

Comparison of the effects of 2 groups of patients after nursing

Comparing the 2 groups, the effective rate of sleep improvement in the observation group was 96.6%, the cure rate was as high as 49.1%; the control group was 82.0%, and the cure rate was 18.0%. The observation group was higher than the control group, and the difference was statistically significant (P < 0.05). See Table 3.

DISCUSSION

Arthroplasty is currently showing an increasing trend in clinical surgery. Due to the imperfect infrastructure, patients often have multiple complications after surgery. Clinical studies have shown that insomnia is a common complication of perinatal period in patients undergoing arthroplasty, which affects the physical and mental health of patients. After joint replacement surgery,patients have limited mobility and painful symptoms.Some patients may have anxiety. Negative emotions such as depression reduce the patient's treatment compliance,which is not conducive to postoperative recovery[6].Clinical psychological nursing is of great significance in the perioperative period of patients undergoing joint replacement surgery, which can effectively help patients to relieve insomnia and improve a series of negative emotions caused by insomnia[7]. Music has the effectsof self-cultivation and tranquility. Music therapy, as a kind of art therapy, is now mature and has achieved good results in clinical psychotherapy[8]. As a branch of music therapy, TCM five-element music nursing is an important application of TCM concept in modern nursing.In this study, perioperative nursing was performed on patients undergoing joint replacement surgery with the combination of TCM and five-element music. The aim was to help improve the quality of sleep and further promote postoperative recovery[6]. The TCM five-element music therapy is a kind of nursing method based on the concept of TCM. It adopts the targeted treatment of traditional Chinese five-tone (Gong, Shang, Jue, Zhi, Yu)[9].There are also reports on music therapy abroad, and some clinical effects have been achieved[10].

Table 3. Comparison of curative effects between the 2 groups after nursing care (n/%)

In this study, the effects of TCM five-element music combined with acupoint application on perioperative sleep quality in patients undergoing joint replacement surgery was analyzed. The specific results were as follows. After 2 weeks of nursing, the patient's negative emotion and PSQI score were significantly improved.In comparison, the effective rate of patients with sleep improvement in the observation group was 96.6%, which was significantly higher than that in the control group(82.0%). Postoperative care in patients undergoing joint replacement surgery is of great significance in the perioperative period of the patient. Patients with joint replacement surgery are prone to mood swings due to their special postoperative period, which leads to a series of psychological problems that affect the normal life and sleep quality of patients[11]. Studies have shown that patients with joint replacement surgery are prone to negative emotions such as anxiety and depression, which further affect the quality of sleep and trigger a series of adverse reactions[12].

Foreign studies have shown that insomnia and sleep quality problems are important risk factors for many types of diseases. Clinical patients have symptoms of insomnia,which must be paid attention by relevant medical staff and timely intervention should be applied[13]. In this study,routine psychological care was performed for all patients,and targeted health education was conducted for some questions about arthroplasty. The caregiver provided the patient with an understanding of the basics of joint replacement surgery through lectures and the distribution of knowledge manuals. The observation group was added with acupoint application therapy and TCM five-element music nursing on basis of routine nursing. It was recorded in the Chinese medicine classic Inner Canon of Huangdi that "heaven has five sounds, man five-zang-organs",which was the earliest theoretical basis of music therapy of TCM five-element music therapy[14]. In the treatment of TCM, the five-zang-organs can affect the five-tone, and the five-tone can regulate the five-zang-organs. The fivezang-organs, spleen, lung, liver, heart and kidney of the human body correspond to Gong, Shang, Jue, Zhi, Yu in the five-tone respectively, and the harmony coordination of five-zang-organs and five-tone is beneficial to health.This study chose music therapy of Gong, Zhi and Jue corresponding to the spleen, heart and liver of the human body. It is believed in TCM that the heart governs the mental activities, the liver stores soul, and the spleen stores idea. Because of this special period, patients with joint replacement surgery will inevitably think and worry more, which will trigger a series of adverse psychological reactions such as anxiety and depression, affecting the quality of sleep[15].

The music of the TCM five-tone uses Gong tone,Zhi tone and Jue tone corresponding to the spleen, heart and liver of the human body[16]. In patients undergoing joint replacement surgery with insomnia, the root cause is heart yin deficiency, and anxiety and depression leading to blood stasis and emotion disorders[17]. It is believed in TCM that the heart dominates blood, liver stores blood, and spleen governs blood, and heart, liver and spleen disorders are important factors influencing perioperative insomnia in patients undergoing joint replacement surgery[18]. The heart, liver, and spleen correspond to Gong tone, Zhi tone and Jue tone. The Gong tone is solemn, generous and quiet; the Zhi tone is cheerful, easy and lively; the Jue tone is elegant and straightforward. TCM believes that the Gong tone is like"earth", the Zhi tone is like "fire", the Jue tone is like"wood", and "earth" corresponds to the spleen, "fire"corresponds to the heart, and "wood" corresponds to the liver[19]. Therefore, Gong tone can effectively promote the patient's qi and blood biochemistry, the Zhi tone can help the patients to refresh the mind, smooth blood,and the Jue tone has the effect of regulating qi and controlling conveyance and dispersion. According to domestic literature, Anmian (EX-HN22) and Shenmen(HT 7) are the 2 most commonly used acupoints in the clinical treatment of insomnia patients.

In this study, the observation group used the TCM five-element music therapy combined with acupoint application for internal adjustment of organs and external ventilation, significantly improving insomnia, and calming the patients. In summary, the combination of TCM and five-element music combined with acupoint application can improve the perioperative sleep quality of patients undergoing joint replacement surgery, and at the same time helps patients to relieve negative emotions,which is worth promoting.