托烷司琼预防全身麻醉术后恶心呕吐的Meta分析

Tropisetron for the prevention of postoperative nausea and vomiting:a Meta-analysis

目的评价托烷司琼对预防全身麻醉术后恶心呕吐（PONV）发生的疗效和安全性。方法检索PubMed、EBSCO、Cochrane、CNKI和维普等数据库,检索托烷司琼预防PONV的随机对照试验（RCT）,收集符合纳入标准的文献,提取资料,评价纳入研究的文献方法学质量,并且提取出有效数据进行Meta分析,统计学分析采用Rev Man5.0软件。结果符合纳入标准的文章18篇,共包括2 901例试验者。Meta分析结果显示：（1）托烷司琼能有效降低全身麻醉PONV发生率[OR=0.43,95%CI（0.33~0.57）],相对早期[OR=0.66,95%CI（0.44~0.98）]而言,托烷司琼更能有效降低后期[OR=0.41,95%CI（0.25~0.65）]PONV发生率;（2）托烷司琼联合地塞米松与单用托烷司琼相比较,能更有效降低PONV发生率[OR=0.37,95%CI（0.22~0.64）]。（3）托烷司琼与格拉司琼和昂丹司琼比较差异无统计学意义（P〉0.05）,分别为[OR=1.08,95%CI（0.68~1.73）],[OR=0.77,95%CI（0.27~2.21）]。（4）托烷司琼与地塞米松相比差异无统计学意义[OR=1.06,95%CI（0.49~2.30）]。结论托烷司琼能明显降低全身麻醉患者PONV的发生率,与其他非5-HT3拮抗剂类止吐药如地塞米松联合用药效果更佳。

Objective To evaluate the efficacy and safety of tropisetron for the prevention of postoperative nausea and vomi -ting （PONV） after general anesthesia .Methods We searched the PubMed ,EBSCO ,Cochrane ,CNKI and Weipu database to identi-fy randomized controlled trials （RCT ） about tropisetron in preventing PONV after general anesthesia .The methodological quality of the included RCT was assessed and data were extracted .The meta-analyses were performed by Rev Man5 .0 software .Results A total of 18 RCT met the inclusion criteria ,involving 2 901 patients .All RCT were randomized double-blind experiments .The results of meta-analyses showed that ：（1）tropisetron could significantly decrease the incidence of PONV after general anesthesia ,[OR =0 .43 ,95% CI（0 .33 - 0 .57）] ,the efficacy in later period [OR = 0 .41 ,95% CI（0 .25 - 0 .65）] was better than that in earlier period [OR = 0 .66 ,95% CI（0 .44 - 0 .98）] ;（2）compared with tropisetron ,the combination of tropisetron and dexamethasone could signifi-cantly decrease the incidence of PONV [OR = 0 .37 ,95% CI（0 .22 - 0 .64）] ;（3）compared with granisetron or ondansetron ,tropise-tron could not significantly decrease the incidence of PONV ,the OR was [OR = 1 .08 ,95% CI（0 .68 - 1 .73）] and [OR = 0 .77 ,95%CI（0 .27 - 2 .21）] respectively ;（4）compared with dexamethasone ,tropisetron could not significantly decrease the incidence of PONV [OR = 1 .06 ,95% CI（0 .49 - 2 .30）] .Conclusion Tropisetron can significantly decrease the incidence of PONV after general anesthesia .It has also the advantage of decreasing incidence of the incidence of PONV combined with other non-5 HT-3 receptor in-hibitor such as dexamethasone .