Grafton-Clarke Ciaran, Grace Laura, Roberts Neil, Harky Amer
School of Medicine, Department of life sciences, University of Liverpool, Liverpool, UK.
Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2019 May 1;28(5):716-721. doi: 10.1093/icvts/ivy310.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'In patients undergoing cardiac surgery, is postoperative massage therapy effective in reducing pain, anxiety and physiological parameters?' Altogether, 287 papers were found using the reported search, of which 7 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and the results of these papers are tabulated. The specific therapy protocols widely varied between studies, with differences in frequency, specific timing in the postoperative period, techniques used and experience of therapy provider. These variations limit the generalization and transferability of the conclusions. The effect of massage therapy on anxiety levels was reported in 5 studies. All but one demonstrated a significant improvement in anxiety. Pain was also reported in 5 studies, with significant improvement demonstrated in 4 studies. Importantly, a number of these studies failed to report on analgesic requirements nor demonstrate a reduction in opioid requirements, thus limiting the validity of the drawn conclusions. There is significant heterogeneity in randomized trials reporting on the effects of massage therapy. Although there is evidence to suggest that massage therapy reduces pain and anxiety following cardiac surgery, there are often caveats to the conclusions drawn with other studies reporting no significant difference. Therefore, in light of this, it would not be logical to recommend massage therapy as an effective therapy. There is no current evidence to suggest that massage therapy improves physiological parameters, including the onset of atrial fibrillation postoperatively.
一篇心脏外科的最佳证据主题文章是根据结构化方案撰写的。所探讨的问题是：“在接受心脏手术的患者中，术后按摩疗法在减轻疼痛、焦虑和生理参数方面是否有效？”通过报告的检索共找到287篇论文，其中7篇论文代表了回答该临床问题的最佳证据。现将这些论文的作者、期刊、发表日期和国家、所研究的患者群体、研究类型、相关结果及结果制成表格。不同研究之间的具体治疗方案差异很大，在频率、术后具体时间、使用的技术以及治疗提供者的经验等方面均有不同。这些差异限制了结论的普遍性和可转移性。5项研究报告了按摩疗法对焦虑水平的影响。除一项研究外，其他所有研究均表明焦虑有显著改善。5项研究也报告了疼痛情况，4项研究表明疼痛有显著改善。重要的是，其中一些研究未报告镇痛需求，也未证明阿片类药物需求减少，因此限制了所得结论的有效性。在报告按摩疗法效果的随机试验中存在显著异质性。虽然有证据表明按摩疗法可减轻心脏手术后患者的疼痛和焦虑，但其他一些研究得出的结论往往存在限制条件，报告无显著差异。因此，鉴于此，推荐按摩疗法作为一种有效疗法是不合理的。目前没有证据表明按摩疗法能改善生理参数，包括术后房颤的发生情况。
