用音乐挽救早产儿生命

Live Music’s Charms, Soothing Premature Hearts
By PAM BELLUCK August 10, 2013
个人健康
用音乐挽救早产儿生命
PAM BELLUCK 2013年08月10日
Even the Beatles would have had trouble recognizing their peppy song in the lullaby that Andrea Zalkin sang to the tiny, fragile baby clutched to her chest in the neonatal unit. But there was something unintentionally poignant in the title she chose for her son: “Eight Days a Week” is more time than can fit on the calendar. Ms. Zalkin’s baby, Hudson, born 13 weeks early, has had too little time.
新生儿病房中，安德烈娅·扎尔金(Andrea Zalkin)为怀抱在胸前的幼小、柔弱的宝宝哼唱着催眠曲——恐怕连披头士乐队自己也辨认不出她唱的正是他们的劲爆曲目《一周八天》(Eight Days a Week)。扎尔金女士为儿子选择的这首歌无意中透露出了她心底的辛酸：她多么希望一周所包含的时间可以比日历上更为长久，因为她的宝宝赫德森(Hudson)早产了13周，他的发育时间太短了。
As she sang, monitors showed Hudson’s heartbeat slowing and his oxygen saturation increasing. Effects like that were among the findings of a new study on the use of music as medicine.
随着她的哼唱，监测仪显示出哈德森的心跳逐渐减慢，血氧饱和度则逐渐增加。这一效果恰恰与一项将音乐作为医疗手段的新研究的结果类似。
Beth Israel Medical Center in New York City led the research, conducted in 11 hospitals, which found that live music can be beneficial to [要查看本链接请先注册并登录]. In the study, music therapists helped parents transform their favorite tunes into lullabies.
在这项由纽约贝斯以色列医学中心(Beth Israel Medical Center)领导，在11家医院中进行的研究中，音乐治疗师帮助父母们将自己喜爱的曲调改编为催眠曲，且研究发现，现场音乐可能对[要查看本链接请先注册并登录]有益。
[要查看本图请先注册并登录]
Michael Nagle for The New York Times
在贝斯以色列医学中心，安杰拉·费拉约洛-汤普森哼唱一种披头士的歌来安抚早产13周的哈德森。
The researchers concluded that live music, played or sung, helped to slow infants’ heartbeats, calm their breathing, improve sucking behaviors important for feeding, aid sleep and promote states of quiet alertness. Doctors and researchers say that by reducing stress and stabilizing vital signs, music can allow infants to devote more energy to [要查看本链接请先注册并登录].
研究人员得出结论：现场演奏或演唱的音乐可帮助婴儿减缓心跳，平静呼吸，改善吮吸行为（这对于进食非常重要），促进睡眠和安静的警觉状态。医生和研究人员表示，通过减少应激并稳定生命体征，音乐令婴儿得以将更多的精力投入[要查看本链接请先注册并登录]。
And while the effects may be subtle, small improvements can be significant. Premature births have increased since 1990, to nearly 500,000 a year, one of every nine children born in the United States.
虽然这一效果可能相当微小，但即使是小幅的改善也可能意义重大。自1990年以来，美国的早产儿数量已增加至每年近50万例，即每九名新生儿中就有一名是早产儿。
The study, published Monday in the journal Pediatrics, adds to growing research on music and preterm babies. Some hospitals find music as effective as, and safer than, sedating infants before procedures like heart sonograms and brain monitoring. Some neonatologists say babies receiving music therapy leave hospitals sooner, which can aid development and family bonding and save money.
目前，关于音乐和早产儿的研究日益增多，这项发表于周一的《儿科学》(Pediatrics)杂志上的研究只是其中之一。一些医院发现，在对婴儿进行心脏超声检查和脑部监测程序之前，音乐与镇静操作同样有效，却更加安全。也有新生儿科医师提出，接受音乐治疗的婴儿出院较早，这有助于婴儿发育、家庭和睦和节约费用。
Dr. Thomas Truman, the director of neonatal and pediatric intensive care at Tallahassee Memorial Hospital in Florida, which was not involved in the study, said infants who had music played to them went home earlier “at least by a couple of days, compared to babies that weren’t getting music therapy.”
佛罗里达州塔拉哈西纪念医院(Tallahassee Memorial Hospital)的新生儿及儿科重症监护科主任托马斯·杜鲁门(Thomas Truman)博士并没有参与这项研究，但他表示：“与未接受音乐疗法的婴儿相比，聆听音乐演奏的婴儿的出院时间至少提前了一两天。”
The music, he said, “helps decrease their stress response” and “really devote more of their oxygen and calories to developing and growing.”
音乐“有助于减少婴儿的应激反应”，杜鲁门博士补充道，“使他们能将更多的氧气和能量切实用于生长发育。”
One reason may be that music is organized, purposeful sound amid the unpredictable, overstimulating noise of neonatal units. “Loud machinery, medical rounds coming through with 12 people, alarms on ventilators and pumps, the hiss of oxygen,” said Helen Shoemark, a music researcher at [要查看本链接请先注册并登录] in Melbourne, Australia. “Sound can be damaging. But meaningful noise is important for a baby’s brain development.”
这种效果背后的原因可能是，新生儿病房里充斥着各种不可预测、过度刺激的噪音，澳大利亚墨尔本[要查看本链接请先注册并登录](Murdoch Childrens Research Institute)的音乐研究员海伦·思玛柯(Helen Shoemark)解释道：“机械的聒噪声、12名医务人员来来往往的查房声、通气机和泵的警报声、输氧装置的嘶嘶声等。”在这其中，唯有音乐是一种有条理，有意义的声音。“声音可造成损害。但有意义的声响对于婴儿的脑部发育非常重要。”
Scientists are far from done determining music’s impact, and there are certainly those who are skeptical about its medical value.
现有的研究还远远不足以令科学家们对音乐的影响做出定论。当然，对音乐的医疗价值表示怀疑的也大有人在。
Dr. Manoj Kumar, a neonatologist at [要查看本链接请先注册并登录] in Edmonton, Alberta, said that while “studies have shown a benefit in heart rate and respiratory rate,” it is unclear whether that prompts clinical improvements, like removing oxygen or feeding tubes sooner, questions that the Pediatrics study did not tackle.
加拿大艾伯塔省埃德蒙顿市[要查看本链接请先注册并登录](Stollery Children’s Hospital)的新生儿科医师马诺杰·库马尔(Manoj Kumar)博士指出，虽然“研究显示，音乐有益于婴儿的心率和呼吸频率”，但目前尚不清楚该效益能否带来临床上的改善，如使婴儿更快地脱离氧气管或食饲管等。而发表在《儿科学》上的这一研究并没能解决这些问题。
The two-year study, larger and more systematic than many efforts to scientifically evaluate art’s impact, separated musical elements — rhythm, melody, timbre — to see effects on heartbeat, breathing, sucking, alertness and sleep.
与从科学角度评估艺术的影响的许多工作相比，这一为期两年的研究规模更大，也更加系统。它将音乐的各种元素，如节奏、旋律、音色等彼此分离，分别观察其在婴儿的心跳、呼吸、吮吸、警觉和睡眠等方面带来的效果。
Over two weeks, 272 premature babies underwent several sessions of two instruments, singing and no music at all. The instruments and lullaby singing style were intended to approximate womb sounds, said Joanne Loewy, the study’s leader and the director of Beth Israel’s [要查看本链接请先注册并登录].
在两周期间，272名早产儿或完全不听音乐，或聆听了由两种乐器演奏或人声演唱的若干音乐片段。该研究的领导者、贝斯以色列医学中心的[要查看本链接请先注册并登录](Louis Armstrong Center for Music and Medicine)主任乔安妮·洛伊(Joanne Loewy)说，他们刻意使这些乐器的演奏风格和摇篮曲的演唱风格近似于子宫内的声音。
Two-tone heartbeat rhythms were played on a “gato box,” a rectangular wooden drum. Whooshing sounds came from an “ocean disc,” a cylinder containing shifting metal beads. For melody, parents were asked for a favorite song. If it wasn’t a lullaby (someone chose “I Heard It Through the Grapevine”; another, “Pick Up the Pieces,” by Average White Band), therapists slowed it, changed meters to lilting waltzes and adjusted lyrics.
使用一种名为“加托盒”(gato box)的长方形木鼓可模仿出心跳的双音节奏。一种名为“海洋盘”(ocean disc)的含有可转动的金属珠的圆筒则可演奏出呼呼声。在旋律方面，研究人员询问了父母们最喜欢的歌曲。如果那本身并不是一首催眠曲（比如，有人选择了《道听途说》[I Heard It Through the Grapevine]，也有人选择了普通白人乐队[Average White Band]的《破镜重圆》[Pick Up the Pieces]），治疗师就将其节奏放缓，改编为轻快的圆舞曲，并对歌词进行调整。
“Lots of times you see parents bopping the baby up and down on their lap, and there’s no purpose to it,” Dr. Loewy said. “You don’t feel the music intention as much as if you have a song that a parent has chosen.”
“你常常能看到父母们漫无目的地将宝宝放在自己的大腿上，托着宝宝让他们跟着波普爵士舞的节奏‘蹦蹦跳跳’，”洛伊博士说，“但其中的音乐意向并不像父母选择的歌曲那样明显。”
If parents did not specify, researchers used “Twinkle, Twinkle, Little Star.” Tempos were coordinated with babies’ vital signs, indicated not only by monitors but also by eye movements and a chest’s rise and fall.
如果父母们没有指定歌曲，研究人员就统一使用《一闪一闪小星星》(Twinkle, Twinkle, Little Star)。监测仪及婴儿的眼球运动和胸廓起伏均显示，这些音乐的节拍可与婴儿的生命体征相协调。
Researchers found that the gato box, the ocean disc and singing all slowed a baby’s heart rate, though singing seemed to be most effective. Singing also increased the time babies stayed quietly alert. Sucking behavior improved most with the gato box. The breathing rate slowed the most and sleeping was the best with the ocean disc.
研究人员发现，“加托盒”、“海洋盘”和哼唱均可减缓婴儿的心率，但哼唱似乎最为有效。哼唱也可延长婴儿处于安静的警觉状态的时间。而“加托盒”对吮吸行为的改善作用最为明显；在“海洋盘”的演奏中，婴儿的呼吸最为缓慢，睡眠质量也最佳。
Babies hearing songs their parents chose had better feeding behavior and gained more calories than those who heard “Twinkle, Twinkle, Little Star.” But the “Twinkle” babies had slightly more oxygen saturation in their blood. The music also lowered parental stress, the study found.
将聆听其父母选择的歌曲的婴儿与聆听《一闪一闪小星星》的婴儿相比，前者在进食行为方面表现较好，从饮食中摄取的能量也较多，但后者的血氧饱和度略高。此外，研究还发现，音乐可降低父母们的应激水平。
Dr. Loewy, who [要查看本链接请先注册并登录], said it did not matter whether parents or music therapists sang, or whether babies were in incubators or held. So they would not have to buy the instruments, parents were taught to mimic them.
洛伊博士对[要查看本链接请先注册并登录]，并指出，无论父母或音乐治疗师哼唱什么内容，无论婴儿是身在保温箱内或在怀抱中，这些都不重要。所以，父母们无需购买乐器，专家们会教导他们如何模仿这些乐器的声音。
Dr. Lance A. Parton, associate director of the regional neonatal intensive care unit at Westchester Medical Center’s [要查看本链接请先注册并登录], which participated in the research, said it would be useful to see if music could help the sickest and most premature babies, who were not in the study.
参与该研究的[要查看本链接请先注册并登录](Maria Fareri Children’s Hospital)威彻斯特医学中心(Westchester Medical Center)的地区新生儿重症监护病房副主任兰斯·A·帕顿(Lance A. Parton)博士表示，最虚弱的患儿和最不足月的早产儿均未参加该研究，但考察音乐能否对这些婴儿有所助益将大有益处。
“There’s definitely a big buzz about music therapy,” Dr. Parton said. “It used to be only academic ivory tower institutions. But with all the high-tech things we can do for babies, there are many low-tech things — and music therapy is part of that.”
“音乐疗法必定会引发诸多争议，”帕顿博士说，“曾几何时，音乐只属于学术的象牙塔。但在高科技的辅助下，音乐疗法等众多低技术含量的手段也可以用于为婴儿造福。”
While the Pediatrics study involved live music, some programs use recordings. [要查看本链接请先注册并登录], a professor of medical music therapy at Florida State University, developed the [要查看本链接请先注册并登录], a pacifier that plays recordings of women singing when infants suck correctly, speeding the babies’ ability to feed independently.
虽然《儿科学》杂志上刊登的这项研究使用的是现场音乐，但也有一些项目使用了录音。美国佛罗里达州立大学音乐疗法教授[要查看本链接请先注册并登录](Jayne M. Standley)研制出了“[要查看本链接请先注册并登录]”(Pacifier Activated Lullaby)。当婴儿以正确的方式吮吸奶嘴时，奶嘴就会播放女声哼唱的录音，从而加速婴儿获得独立进食能力的进程。
“Live music is optimal because it’s in the moment and can adapt to changing conditions,” Dr. Standley said. “If the baby appears to be falling asleep, you can sing quieter. Recorded music can’t do that. But there are so many premature babies and so few trained live producers of music therapy that it’s important to know what recorded music can do.”
“现场音乐效果最佳，因为它是即兴的，可以适应不断变化的环境，”斯坦德利博士说，“随着宝宝的逐渐入睡，你哼唱的声音就要逐步变轻。录制的音乐就无法做到这一点。但由于早产儿的数量如此巨大，而训练有素的音乐疗法现场治疗师非常有限，了解录制的音乐能发挥哪些效应就显得十分重要。”
At Beth Israel, Ms. Zalkin, who said she had discovered that she was pregnant only a week before giving birth in March, said it can feel overwhelming to suddenly have a baby, let alone one who weighed 2 ½ pounds when born. She joined Beth Israel’s music therapy program after the study ended.
3月份，扎尔金女士才发现自己已经怀孕，一周后她就分娩了。她在纽约贝斯以色列医学中心中告诉我们，突然成为母亲让她无所适从，更不用说这个宝宝的出生体重只有2.5磅（1.13千克）。在研究结束后，她加入了该中心的音乐治疗项目。
“With the beeping and the scary noises and the people running around, that’s something that I can’t change,” Ms. Zalkin said. She chose “Eight Days a Week,” she said, because “I grew up on the Beatles.” The therapist, Angela Ferraiuolo-Thompson, changed it to a slow waltz, eventually eliminating the actual lyrics but adding “Baby Hudson” and “aah.”
“我无法改变周围的那些蜂鸣声、可怕的噪音、还有人跑来跑去的声音，”扎尔金女士说，她选择《一周八天》是“因为我是听着披头士的歌长大的”。治疗师安杰拉·费拉约洛-汤普森(Angela Ferraiuolo-Thompson)将这首歌改编成了舒缓的圆舞曲，删去了原来的歌词，将全篇变成“宝贝哈德森”和“啊”之类的哼唱。
Recently, Ms. Ferraiuolo-Thompson, strumming a guitar, directed Ms. Zalkin to sing slower to soothe Hudson’s hiccups.
近日，费拉约洛·汤普森女士弹着吉他，指导扎尔金女士哼唱这首歌来缓解哈德森的持续打嗝问题。
“It changes the way he’s breathing and I’m breathing, it changes his behavior,” Ms. Zalkin said. “Music therapy, it’s something you can do.”
“它改变了他的呼吸方式，以及我的呼吸方式；它改变了他的行为，”扎尔金女士说，“你值得尝试音乐疗法。”