昂丹司琼联合地塞米松对比昂丹司琼单药预防腹腔镜胆囊切除术后恶心呕吐的荟萃分析

目的:系统评价昂丹司琼联合地塞米松与昂丹司琼单药预防腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后恶心呕吐(postoperative nausea and vomiting,PONV)的疗效及安全性,以期为临床用药提供参考。方法:系统检索与筛选Cochrane Library、Pub Med、EMBASE、SCI、CNKI、维普、万方数据库中对比昂丹司琼单药与联合用药预防LC术后PONV的随机对照试验。使用Google学术、百度学术等搜索引擎进一步补充检索。按照纳入与排除标准纳入文献后,由两位作者独立进行质量评价、数据提取,交叉核对后,使用Rev Man 5.3软件统计分析,合并效应量中计数资料采用相对危险度(relative risk,RR)及95%可信区间(confidence interval,CI)描述。结果:纳入12项随机对照试验,共1 156例患者。Meta分析结果显示,相较昂丹司琼单药组,联合地塞米松用药组LC术后24 h内PONV发生率显著下降[RR=0.45,95%CI(0.35,0.57)]。依据药物用量行亚组分析时发现,4 mg、8 mg昂丹司琼联合用药组均可显著降低术后24 h PONV发生率,而在8 mg时较单药组可显著降低总的呕吐发生率[RR=0.40,95%CI(0.23,0.71)]。安全性方面,两组术后其他并发症发生率差异无统计学意义。结论:昂丹司琼联合地塞米松相较昂丹司琼单药能更好地预防LC术后的PONV,有效降低术后不适症状,同时临床应用时应注意昂丹司琼剂量的选择。

A meta-analysis of evaluating ondansetron combined with dexamethasone compared with ondansetron monotherapy on the prevention of nausea and vomiting after laparoscopic cholecystectomy

Objective:To systematically evaluate the therapeutic efficacy and safety of ondansetron combined with dexamethasone with ondansetron monotherapy for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy (LC),and to provide evidence for clinical practice.Methods:Cochrane Library,PubMed,EMBASE,SCI,CNKI,VIP and Wanfang databases were systematically searched for relevant randomized controlled trials (RCT) which investigated combination therapy of ondansetron and dexamethasone with ondansetron alone for PONV in LC patients.Google Scholar,Baidu academic and other search engines were used for further supplement.RCTs were included according to the inclusion and exclusion criteria.Two reviewers independently assessed quality evaluation and extracted data,and statistic analysis was performed by RevMan 5.3 software after cross-check.Qualitative data in overall effects were described using relative risk (RR) and 95% confidence interval (CI).Results:Twelve RCTs involving 1 156 patients were included.Meta-analysis results showed that combination group was associated with a significantly lower incidence of PONV than control group during postoperative 24 h [RR=0.45,95% CI(0.35,0.57)].Subgroup analysis according to the dose of ondansetron indicated that,both 4 mg and 8 mg subgroup of combination group induced significant decrease in PONV during postoperative 24 h,while a significant reduction in total incidence of vomiting postoperatively was only found in 8 mg subgroup [RR=0.40,95% CI(0.23,0.71)].On grounds of safety,there was no significant difference in other complications.Conclusions:Compared with ondansetron monotherapy,combination of ondansetron with dexamethasone can significantly prevent PONV after LC.It reduces the postoperative discomfort of LC,while the dose of ondansetron should be chosen carefully in clinical practice.