Wieting J Michael, Beal Christopher, Roth Gary L, Gorbis Sherman, Dillard Lori, Gilliland Dennis, Rowan Jacob
Department of Physical Medicine and Rehabilitation and Osteopathic Principles and Practice, Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, Tennessee, USA.
J Am Osteopath Assoc. 2013 May;113(5):384-93.
Several studies have investigated the use of osteopathic manipulative treatment (OMT) after coronary artery bypass graft (CABG) operations; however, there is little information regarding the effect of OMT in the postoperative recovery of patients undergoing CABG operations.
Patients scheduled to undergo a CABG operation were voluntarily enrolled and randomly assigned to receive 1 of 3 treatment protocols after their surgical procedure: standardized daily OMT and conventional postoperative care (the OMT group), daily time-matched placebo OMT and conventional postoperative care (the placebo group), or conventional postoperative care only (the control group). Specific OMT techniques used were thoracic inlet myofascial release, standard rib raising (with paraspinal muscle stretch to the L2 vertebral level), and soft tissue cervical paraspinal muscle stretch (with suboccipital muscle release). Primary outcome measures included time to discharge, time to postoperative bowel movement, and FIM functional assessment scores.
Fifty-three patients completed the study protocol: 17 in the OMT group, 18 in the placebo group, and 18 in the control group. After surgical procedures, patients were discharged to home at a mean (standard deviation [SD]) rate of 6.1 (1.4), 6.3 (1.5), and 6.7 (3.0) days for the OMT group, placebo group, and control group, respectively. Patients in the OMT group were discharged 0.55 days earlier than those in the control group and 0.16 days earlier than those in the placebo group. The mean (SD) number of days to first postoperative bowel movement was 3.5 (0.9), 4.0 (0.8), and 4.0 (0.9) for the OMT group, the placebo group, and the control group, respectively. On day 3 after surgery, the mean (SD) total score on the FIM was 19.3 (6.7), 15.4 (7.3), and 18.6 (6.5) for the OMT, the placebo, and the control group, respectively; total score for the OMT group was 0.81 greater than that of the control group and 3.87 greater than that of the placebo group. None of the differences achieved statistical significance (P<.05)
A daily postoperative OMT protocol improved functional recovery of patients who underwent a CABG operation.
多项研究调查了冠状动脉旁路移植术（CABG）后整骨手法治疗（OMT）的应用；然而，关于OMT对接受CABG手术患者术后恢复的影响，相关信息较少。
计划接受CABG手术的患者自愿入组，并在手术后随机分配接受以下三种治疗方案之一：标准化每日OMT和常规术后护理（OMT组）、每日时间匹配的安慰剂OMT和常规术后护理（安慰剂组）或仅常规术后护理（对照组）。使用的具体OMT技术包括胸廓入口肌筋膜松解、标准肋骨提升（伴椎旁肌拉伸至L2椎体水平）和软组织颈段椎旁肌拉伸（伴枕下肌松解）。主要结局指标包括出院时间、术后首次排便时间和FIM功能评估评分。
53例患者完成了研究方案：OMT组17例，安慰剂组18例，对照组18例。手术后，OMT组、安慰剂组和对照组患者出院回家的平均（标准差[SD]）时间分别为6.1（1.4）天、6.3（1.5）天和6.7（3.0）天。OMT组患者比对照组提前0.55天出院，比安慰剂组提前0.16天出院。OMT组、安慰剂组和对照组术后首次排便的平均（SD）天数分别为3.5（0.9）天、4.0（0.8）天和 4.0（0.9）天。术后第3天，OMT组、安慰剂组和对照组FIM的平均（SD）总分分别为19.3（6.7）、15.4（7.3）和18.6（6.5）；OMT组的总分比对照组高0.81，比安慰剂组高3.87。这些差异均未达到统计学意义（P<0.05）。
术后每日OMT方案改善了接受CABG手术患者的功能恢复。
