比较穴位刺激与止吐药防治术后恶心呕吐疗效的Meta分析

Effectiveness of acupoint stimulation versus antiemetics in the prevention and treatment of postoperative nausea and vomiting:A meta-analysis

目的系统评价穴位刺激与止吐药防治术后恶心呕吐(postoperative nausea and vomiting,PONV)的有效性。方法计算机检索PubMed、Embase、the Cochrane Library、CBM、Ovid、VIP、WangFang Data和CNKI数据库,搜索穴位刺激和药物防治PONV的随机对照试验(randomized controlled trial,RCT),检索时限为2000年1月1日至2019年5月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入25个RCT,包括3138例患者。结果显示:穴位刺激组术后恶心[比值比(odds ratio,OR)=0.92,95%CI(0.64,1.32),P=0.65]、术后早期恶心[OR=0.72,95%CI(0.50,1.03),P=0.07]、术后后期恶心[OR=0.86,95%CI(0.51,1.45),P=0.57]及术后呕吐[OR=0.89,95%CI(0.65,1.22),P=0.47]、术后后期呕吐发生率[OR=0.96,95%CI(0.64,1.44),P=0.85]及补救止吐药物使用率[OR=0.71,95%CI(0.42,1.19),P=0.19]与止吐药组比较差异均无统计学意义,但其术后早期呕吐发生率低于止吐药组[OR=0.64,95%CI(0.45,0.90),P=0.01];单独内关穴刺激组术后恶心[OR=0.91,95%CI(0.61,1.36),P=0.66]、术后早期恶心[OR=0.72,95%CI(0.50,1.03),P=0.07]、术后后期恶心[OR=0.86,95%CI(0.51,1.45),P=0.57]及术后呕吐[OR=0.76,95%CI(0.51,1.13),P=0.18]、术后后期呕吐发生率[OR=0.93,95%CI(0.59,1.46),P=0.75]与止吐药组比较差异均无统计学意义,但其术后早期呕吐发生率低于止吐药组[OR=0.60,95%CI(0.40,0.90),P=0.01];穴位刺激联合止吐药组术后恶心及呕吐发生率均低于止吐药组[OR=2.13,95%CI(1.31,3.46),P=0.002;OR=3.93,95%CI(2.06,7.48),P<0.001]。结论穴位刺激可用于防治PONV,其效果与止吐药物相当,其对术后早期呕吐防治效果优于止吐药。穴位刺激联合止吐药可增强防治PONV的效果。受纳入研究数量及质量的限制,上述结论有待更多高质量研究予以验证。

Objective To systematically evaluate the effectiveness of acupoint stimulation versus antiemetic in the prevention and treatment of postoperative nausea and vomiting(PONV).Methods PubMed,Embase,The Cochrane Library,CBM,Ovid,VIP,WangFang Data and CNKI databases were searched to collect randomized controlled trial(RCT)about the prevention and treatment of PONV through acupoint stimulation from January 1,2000 to May 1,2019.Two reviewers independently screened the literature,extracted data and assessed the risk of bias of included studies.Then,meta-analysis was performed using RevMan 5.3 software.Results A total of 25 RCT involving 3138 patients were included.The results showed no statistical differences in the incidence of postoperative nausea,early nausea,late nausea,postoperative vomiting,late vomiting and the use of remedial antiemetics between the acupoint stimulation group and the antiemetic group[odds ratio(OR)=0.92,95%confidence interval(CI)(0.64,1.32),P=0.65],[OR=0.72,95%CI(0.50,1.03),P=0.07],[OR=0.86,95%CI(0.51,1.45),P=0.57],[OR=0.89,95%CI(0.65,1.22),P=0.47],[OR=0.96,95%CI(0.64,1.44),P=0.85]and[OR=0.71,95%CI(0.42,1.19),P=0.19].However,the incidence of early vomiting in the acupoint stimulation group was lower than that in the antiemetic group[OR=0.64,95%CI(0.45,0.90),P=0.01].There was no significant difference in the incidence of postoperative nausea,postoperative early nausea,late nausea,postoperative vomiting and late vomiting between the pericardium 6(P6)stimulation group and the antiemetic group[OR=0.91,95%CI(0.61,1.36),P=0.66],[OR=0.72,95%CI(0.50,1.03),P=0.07],[OR=0.86,95%CI(0.51,1.45),P=0.57],[OR=0.76,95%CI(0.51,1.13),P=0.18]and[OR=0.93,95%CI(0.59,1.46),P=0.75].The incidence of postoperative early vomiting in the P6 stimulation group was lower than that in the antiemetic group[OR=0.60,95%CI(0.40,0.90),P=0.01].The incidence of postoperative nausea and vomiting in the acupoint stimulation combined with antiemetic group was lower than that in the antiemetic group[OR=2.13,95%CI(1.31,3.46),P=0.002]and[OR=3.93,95%CI(2.06,7.48),P<0.001].Conclusions Acupoint stimulation can be used to prevent and treat PONV,and its effectiveness is similar to antiemetics with better effects on postoperative early vomiting.Acupoint stimulation combined with antiemetic can enhance the effect on preventing and treating PONV.Due to limits in the quantity and quality of the included studies,the above conclusions need to be verified by more high-quality studies.