托烷斯琼预防全麻术后恶心呕吐有效性和安全性的Meta分析

目的系统评价托烷斯琼预防全麻术后恶心呕吐的临床效果和安全性。方法电子检索PubMed、EBSCO、Springer、Ovid、CNKI等数据库,并查阅所获文献的参考文献,收集1995～2009年发表的有关托烷斯琼预防全麻术后恶心呕吐的随机对照试验（RCT）。按Cochrane Handbook 5.0.1对纳入文献进行质量评价和资料提取,统计学分析采用RavMan 4.2.10软件。结果共纳入17个RCT,包括4？678例患者。Meta分析结果显示：①有效性：托烷司琼单次静注能降低全麻术后恶心呕吐的发生率[RR=0.41,95%CI（0.29,0.60）]和全麻术后应用阿片类药物镇痛患者恶心呕吐的发生率[RR=0.30,95%CI（0.15,0.60）];单次静注或分次泵注均能降低全麻术后应用曲马多镇痛患者恶心呕吐的发生率[RR（95%CI）分别为0.41（0.29,0.56）和0.10（0.06,0.19）];托烷司琼与地塞米松联用较托烷司琼单用能更有效降低全麻术后患者恶心呕吐的发生率[RR=0.27,95%（0.13,0.57）]。②安全性：托烷司琼静注能减少头晕头迷的发生率[RR=0.35,95%CI（0.16,0.75）],但在减少术后瘙痒、嗜睡方面差异无统计学意义;所有纳入研究患者均未出现椎体外系、排尿困难等症状。结论托烷司琼能明显降低全麻患者术后恶心呕吐的发生率,且不增加瘙痒、嗜睡等不良反应,并可减少头晕头迷的发生。

Efficacy and Safety of Tropisetron for Postoperative Nausea and Vomiting:A Meta-analysis of Randomized Controlled Trials

Objective To evaluate the efficacy and safety of 5 HT-3 receptor inhibitor tropisetron injected in the postoperative nausea and vomiting（PONV）after general anesthesia.Methods We searched the PubMed,EBSCO,Springer,Ovid,and CNKI to identify randomized controlled trials（RCTs）about tropisetron in preventing PONV after general anesthesia from January 1995 to September 2009.We also consulted references of the included studies for omission.The methodological quality of the included RCTs was assessed and data were extracted according to the standard of the Cochrane Handbook 5.0.1.The meta-analyses were performed by RevMan 4.2.10 software.Results A total of 17 RCTs involving 4 678 patients were included.The results of meta-analyses showed that：（1）Efficacy：tropisetron injected could decrease the incidence of PONV after general anesthesia（RR=0.41,95%CI 0.29 to 0.60）,and decrease the incidence of PONV after general anesthesia with opioid drugs in patient controlled analgesia（RR=0.30,95%CI 0.15 to 0.60）;tropistron injected once or more could decrease the incidence of PONV in combination of PCA with tramadol（RR=0.41,95%CI 0.29 to 0.56;RR=0.10,95%CI 0.06 to 0.19）;and tropisetron combined with dexamethasome could also lessen the incidence of PONV（RR=0.27,95%CI 0.13 to 0.57）.（2）Safety：Tropisetron injected could lessen the incidence of postoperative headache and dizziness（RR=0.35,95%CI 0.16 to 0.75）,but could not significantly decrease the pruritus and somnolence.Conclusion Tropisetron injected can significantly decrease the incidence of PONV after general anesthesia,and it will not increase the adverse effect and the incidence of postoperative complications.Furthermore,it has also the advantage of decreasing postoperative headache and dizziness.