腹部按摩对成人慢性便秘的疗效：系统回顾和荟萃分析。

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-10-24 DOI:10.1016/j.ijnurstu.2024.104936

Shiou-Yun Huang , Chia-Yi Chiao , Li-Yin Chien

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引用次数: 0

摘要

背景介绍慢性便秘是一种常见的令人痛苦的症状。腹部按摩是一种安全、无创、舒适的干预方法。然而，由于腹部按摩对慢性便秘的疗效尚不明确，因此很少在正规临床实践中使用：本系统综述旨在研究腹部按摩对成人排便频率、粪便稠度、结肠转运时间、便秘症状、生活质量、泻药使用和不良反应的有效性。此外，我们还旨在比较腹部按摩对不同病因和腹部按摩技术类型的慢性便秘的有效性：方法：我们使用了8个中英文电子数据库中截至2024年5月15日的数据，包括随机对照试验（RCT）和准实验研究。使用 Cochrane 偏倚风险工具评估了偏倚风险。研究结果采用随机效应模型进行综合。本研究于 2023 年 1 月 7 日在国际系统综述前瞻性注册中心（PROSPERO，CRD42023385243）注册：共有23项研究、1431名参与者符合荟萃分析的条件。腹部按摩可明显增加每周排便次数（MD = 1.59; 95 % CI 1.06, 2.11; df = 10; I2 = 82 %），减少肠道转运时间（MD = -21.53 h; 95 % CI -35.94, -7.12; df = 3; I2 = 65 %），与对照组相比，减少了便秘症状（SMD = -1.06; 95 % CI -1.33, -0.80; df = 18; I2 = 79 %）；但并没有减少泻药的使用（OR：0.43, 95 % CI 0.14, 1.34, p = 0.15; I2 = 74 %）。在亚组分析中，排便次数对功能性便秘的有效性似乎更大（SMD = 1.23; 95 % CI 0.87, 1.60; df = 6; I2 = 86 %）与阿片类药物引起的便秘（SMD = 1.06; 95 % CI 0.61, 1.50; df = 5; I2 = 5 %）或神经源性肠功能障碍（SMD = 0.68; 95 % CI 0.26, 1.10; df = 4; I2 = 51 %）相比，排便次数的有效性更高。功能性便秘组和神经源性肠道功能障碍组的排便次数差异有统计学意义（P = 0.075）。指压和香薰按摩对排便次数的影响（SMD = 1.63; 95 % CI 1.06, 2.21; df = 3; I2 = 86 %）大于环形按摩（SMD = 0.90; 95 % CI 0.57, 1.22; df = 10; I2 = 68 %）或电动装置按摩（SMD = 0.83; 95 % CI 0.15, 1.51; df = 1; I2 = 82 %）；然而，研究发现异质性很高，文章数量有限。非神经源性肠道功能障碍组未观察到不良反应：本研究揭示了腹部按摩在缓解慢性便秘症状方面的功效，以及不同便秘类型和按摩技巧的效果差异。Tweetable摘要：腹部按摩对慢性便秘有效，可增加排便次数并改善症状。用户可根据具体的便秘类型调整按摩技巧，以达到最佳效果。#便秘缓解#肠道健康。

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Effectiveness of abdominal massage on chronic constipation in adults: A systematic review and meta-analysis

Background

Chronic constipation is a common distressing symptom. Abdominal massage is a safe, noninvasive, and comfortable intervention. However, it is rarely used in formal clinical practice as its' effectiveness for chronic constipation remains unclear.

Objective

This systematic review aimed to investigate the effectiveness of abdominal massage on defecation frequency, stool consistency, colonic transit time, constipation symptoms, quality of life, laxative use, and adverse events in adults. Additionally, we aimed to compare the effectiveness of abdominal massage in chronic constipation with different etiologies and types of abdominal massage techniques.

Methods

Data from eight English and Chinese electronic databases until May 15, 2024, including randomized controlled trials (RCT) and quasi-experimental studies, were used. The risk of bias was assessed using the Cochrane risk-of-bias tool. Results were synthesized using a random-effect model. This study was registered on the 7th of January 2023 to the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023385243).

Results

A total of 23 studies with 1431 participants were eligible for the meta-analysis. Abdominal massage statistically significantly increased weekly defecation frequency (MD = 1.59; 95 % CI 1.06, 2.11; df = 10; I² = 82 %), decreased gut transit time (MD = − 21.53 h; 95 % CI − 35.94, − 7.12; df = 3; I² = 65 %), and decreased constipation symptoms (SMD = − 1.06; 95 % CI − 1.33, − 0.80; df = 18; I² = 79 %) as compared to the control group; however, it did not reduce laxative use (OR: 0.43, 95 % CI 0.14, 1.34, p = 0.15; I² = 74 %). In subgroup analysis, the effectiveness of defecation frequency appeared to be greater for functional constipation (SMD = 1.23; 95 % CI 0.87, 1.60; df = 6; I² = 86 %) as compared to opioid-induced constipation (SMD = 1.06; 95 % CI 0.61, 1.50; df = 5; I² = 5 %) or neurogenic bowel dysfunction (SMD = 0.68; 95 % CI 0.26, 1.10; df = 4; I² = 51 %). There were statistically significant differences in defecation frequency between the functional constipation and neurogenic bowel dysfunction groups (p = 0.075). Acupressure and aromatherapy massage had a greater effect on defecation frequency (SMD = 1.63; 95 % CI 1.06, 2.21; df = 3; I² = 86 %) than circular massage (SMD = 0.90; 95 % CI 0.57, 1.22; df = 10; I² = 68 %) or electric device massages (SMD = 0.83; 95 % CI 0.15, 1.51; df = 1; I² = 82 %); however, high heterogeneity and a limited number of articles were encountered. No adverse reactions were observed in the non-neurogenic bowel dysfunction group.

Conclusion

This study reveals the efficacy of abdominal massage in alleviating symptoms of chronic constipation, as well as the differences in the effectiveness of different constipation types and massage techniques. Patients, caregivers, and health professionals can select abdominal massage techniques based on their effectiveness in specific type of constipation or troublesome symptoms.

Tweetable abstract: Abdominal massage is effective for chronic constipation, increasing defecation frequency and improving symptoms. Users can tailor massage technique to specific constipation type for optimal results. #ConstipationRelief #GutHealth.

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).