腹部按摩於改善脊髓損傷者神經性腸道功能障礙之成效－－系統性文獻回顧

The Effectiveness of Abdominal Massage on Neurogenic Bowel Dysfunction in Patients With Spinal Cord Injury: A Systematic Review

背景：神經性腸道功能障礙是造成脊髓損傷病人大便失禁常見的合併症，腹部按摩為腸道訓練的步驟之一，可增進腸蠕動與促進排便。目的：旨在透過系統性文獻回顧研究方式，探討腹部按摩運用於改善脊髓損傷病人神經性腸道功能障礙之成效。方法　以系統性文獻回顧方式，運用「脊髓損傷」、「腹部按摩」、「神經性腸道功能障礙」、「腸道訓練」等關鍵字，於中、英文6個資料庫進行搜尋。主要選取截至2016年6月符合納入與排除條件之相關文獻，使用Downs 及 Black量表進行文獻評讀，最後納入8篇文獻進行分析。結果　有4篇文獻顯示腹部按摩介入後，分別在腸道功能、排便時間與排便頻率上有顯著改善；2篇分別顯示在甘油球與瀉劑使用上獲得顯著改善，另兩篇則無成效。分析文獻品質得分介於13至25分之間。結論／實務應用　文獻樣本中，以腹部按摩對改善脊髓損傷病人神經性腸道功能障礙之成效仍不一致。未來應以更嚴謹之實驗性研究設計，例如：以隨機對照研究來探討按摩時間、按摩頻率以及腸道功能改善之關係，以提供臨床照護之指引及運用。

Background: Neurogenic bowel dysfunction is a common comorbidity in spinal cord injury patients that may result in fecal incontinence. Abdominal massage is one intestinal training method that is used to improve bowel movement and defecation. Purpose: To review the effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury. Methods: A systematic review of Chinese and English-language articles was performed in six databases using the following key words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction, and bowel training. Relevant studies published prior to June 2016 that met the inclusion and exclusion criteria were selected. The Downs and Black scale was used to appraise the quality of each of the included studies. Eight studies were included in the final analysis. Results: Four of these studies indicated that abdominal massage significantly improved bowel functions and the regularity and frequency of bowel movements. Although two of the studies indicated that abdominal massage significantly reduced the use of glycerin and laxatives, the remaining six did not. The eight studies earned respective quality scores ranging between 13 and 25. Conclusions / Implications for Practice: The current literature lacks consensus on the efficacy of abdominal massage in terms of improving bowel dysfunction in patients with spinal cord injuries. Future studies should use more stringent experimental designs such as randomized controlled studies to explore the correlations among massage time and frequency and bowel function improvements in order to provide guidelines for clinical care applications.