小剂量纳洛酮对阿片类药物相关术后恶心呕吐及术后疼痛影响的Meta分析

The effect of low dose naloxone on opioid related postoperative nausea and vomiting and postoperative pain:A Meta-analysis

目的通过Meta分析评价小剂量纳洛酮对阿片类药物相关术后恶心呕吐的影响。方法检索PubMed、Embase、Cochrane、中国知网、维普和万方数据库,检索建库至2021年3月1日小剂量纳洛酮对阿片类药物相关术后恶心呕吐影响的随机对照实验(Randomized controlled trial,RCT),使用RevMan 5.3软件进行Meta分析。结果本研究纳入RCT实验共17项,患者总1600例,其中实验组927例,对照组673例。阿片类药物联合小剂量纳洛酮恶心发生率明显减低[OR=0.47,95%CI(0.37,0.61),P<0.001];阿片类药物联合小剂量纳洛酮呕吐发生率明显减低[OR=0.51,95%CI(0.34,0.77),P=0.001];阿片类药物联合小剂量纳洛酮的VAS疼痛评分低于单独使用阿片类药物[MD=-0.08,95%CI(-0.15,-0.00),P=0.04]。结论阿片类药物联合小剂量纳洛酮可降低阿片类药物相关术后恶心呕吐等不适反应,并对其镇痛效果有增强作用。

Objective To evaluate the effect of low-dose naloxone on opioid-related postoperative nausea and vomiting through Meta analysis. Methods The randomized controlled trials(RCTs) about the effects of low-dose naloxone on opioid-related postoperative nausea and vomiting were searched in PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang databases from the establishment of the database until March 1, 2021. The meta-analysis was conducted by using RevMan 5.3. Results A total of 17 RCT experiments were included in this study, with a total of 1,600 patients, including 927 in the experimental group and 673 in the control group. The results showed that: The incidence of nausea with opioids combined with low-dose naloxone was significantly reduced [OR=0.47, 95%CI(0.37, 0.61), P<0.001]. The incidence of vomiting with opioids combined with low-dose naloxone was significantly reduced [OR=0.51, 95%CI(0.34, 0.77), P=0.001]. The VAS pain score of opioid combined with low-dose naloxone was lower than opioid alone [MD=-0.08, 95%CI(-0.15,-0.00), P=0.04]. Conclusion The combination of opioids and low-dose naloxone can reduce the occurrence of opioid-related postoperative nausea and vomiting and enhance the analgesic effect of opioids.