5-羟色胺受体拮抗剂预防丙泊酚注射痛有效性和安全性的Meta分析

Effectiveness and Safety of 5-HT3 Receptor Antagonists in Preventing Propofol Injection Induced Pain: A Meta-Analysis

目的系统评价5-羟色胺(5-HT3)受体拮抗剂预防丙泊酚注射痛的有效性和安全性。方法计算机检索PubMed、EMbase、e Cochrane Library(2012年第1期)、CNKI、CBM、VIP和WanFang Data,查找有关5-HT3受体拮抗剂预防丙泊酚注射痛的随机对照试验(RCT),检索时限均从建库至2012年9月。由2位研究人员按照纳入和排除标准独立筛选文献、提取资料和评价质量后,然后采用RevMan 5.2软件进行Meta分析。结果最终纳入15个RCT,共1 413例患者。Meta分析结果显示:①5-HT3组丙泊酚注射痛发生率明显小于对照组[RR=0.14,95%CI(0.09,0.21),P<0.000 01];②在疼痛程度方面,两组轻度注射痛差异无统计学意义[RR=0.84,95%CI(0.56,1.26),P=0.39];5-HT3组丙泊酚中度注射痛[RR=0.25,95%CI(0.19,0.34),P<0.000 01]和重度注射痛的发生率[RR=0.16,95%CI(0.10,0.24),P<0.000 01]均明显低于对照组。③在术后不良反应方面,5-HT3组术后恶心和呕吐[RR=0.19,95%CI(0.11,0.34),P<0.000 01]及寒颤[RR=0.20,95%CI(0.12,0.33),P<0.000 01]的发生率均明显少于对照组。结论 5-HT3受体拮抗剂能有效预防丙泊酚注射痛,且能减轻丙泊酚注射的疼痛程度和术后不良反应发生率。受纳入研究的数量和质量限制,上述结论尚待开展更多高质量研究加以验证。

Objective To systematically assess the effectiveness and safety of 5-HT3 receptor antagonists in prevent- ing propofol injection induced pain. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 1, 2012）, CNKI, CBM, VIP and WanFang Data were searched from their inception to September, 2012 to collect the ran- domized controlled trials （RCTs） about 5-HT3 receptor antagonists in preventing propofol injection induced pain. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 15 RCTs involving 1 413 patients were included. The results of meta-analysis showed that： a） the incidence of propofol iniection induced pain in the 5-HT3 group was obviously lower than the control group （RR=0.14, 95%CI 0.09 to 0.21, P〈0.000 01）; b） as to the severity of pain, there was no statistical difference between the two groups （RR=0.84, 95%CI 0.56 to 1.26, P=0.39）; the 5-HTs group was obviously lower that the control group in the incidence of both moderate pain （RR=0.25, 95%CI 0.19 to 0.34, P〈0.000 01） and severe pain （RR=0.16, 95%CI 0.10 to 0.24, P〈0.000 01）; and c） as to the in- cidence of postoperative adverse reaction： the 5-HT3 group was obviously lower that the control group in the incidence of nausea and vomiting （RR=0.19, 95%CI 0.11 to 0.34, P〈0.000 01） and shivering （RR=0.20, 95%CI 0.12 to 0.33, P〈0.000 01） as well. Condusion 5-HTs receptor antagonists can effectively prevent the propofol injection induced pain, alleviate its severity, and reduce the postoperative adverse reactions. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.