雷莫司琼对脊柱手术后恶心呕吐的影响:一项荟萃分析

IF 1.6 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Current Therapeutic Research-clinical and Experimental Pub Date : 2022-01-01 DOI:10.1016/j.curtheres.2022.100666

Yiyun Lin MD, Sun Tiansheng MMS, Zhang Zhicheng, Chen Xiaobin, Li Fang

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引用次数: 2

摘要

背景:脊柱手术与术后最初几天的剧烈疼痛相关。阿片类药物通常用于控制术后疼痛，但会导致术后恶心和呕吐(PONV)。因此，使用更有效和耐受性更好的药物将对这些患者有益。5 -羟色胺受体拮抗剂，如雷莫司琼，已被用于减少麻醉患者的PONV。目的对已发表的随机对照试验(rct)进行荟萃分析，比较雷莫司琼预防脊柱术后PONV的疗效和耐受性。方法系统检索medline、Embase、Cochrane Library和Science Citation Index数据库1979年1月至2020年11月间发表的相关RCT文章。对成人脊柱手术后使用雷莫司琼和其他5 -羟色胺拮抗剂治疗PONV的随机对照试验进行meta分析。两名审稿人独立完成了所有文章的研究选择、质量评估和数据提取。分歧由第三位审稿人解决。结果检索到88篇可能相关的文章，其中只有3篇符合我们的选择标准。所有纳入的3篇文章均在脊柱手术结束时给予研究药物。荟萃分析显示，雷莫司琼(0.3 mg)可降低疼痛评分(平均差异 = −0.66;95% CI为−1.02 ~−0.30)，降低了PONV的风险(风险比 = 0.86;95% CI, 0.76-0.97)和术后呕吐(风险比 = 0.32;95% CI, 0.17-0.60)，并限制使用抢救止吐药(风险比 = 0.66;95% CI, 0.45-0.96)。然而，雷莫司琼与帕洛诺司琼(0.075 mg)或昂丹司琼(4mg)在术后恶心发生率、止痛药物的使用、止痛药物的使用数量以及患者自控镇痛的停药风险方面没有显著差异。三种药物不良事件发生风险差异无统计学意义。结论3项rct荟萃分析显示，在3项rct中，与帕洛诺司琼或昂丹司琼相比，雷莫司琼降低了脊柱术后PONV和POV的风险，限制了救救性止吐药的使用，降低了术后疼痛评分，并且没有增加患者停止自控镇痛的风险。因此，这项荟萃分析表明，雷莫司琼是一种有效且耐受性良好的止吐药，可用于预防成人脊柱手术后的PONV。PROSPERO标识符:CRD42020223596 (Curr therres clinclinexp . 2022;83: XXX-XXX)©2022 Elsevier HS Journals, Inc。

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Effects of Ramosetron on Nausea and Vomiting Following Spinal Surgery: A Meta-Analysis

Background

Spinal surgery is associated with severe pain within the first few days after surgery. Opioids are commonly used to control postoperative pain, but these can lead to postoperative nausea and vomiting (PONV). Therefore, use of more effective and better-tolerated agents would be beneficial for these patients. Serotonin receptor antagonists, such as ramosetron, have been used to reduce PONV in patients receiving anesthesia.

Objective

We conducted a meta-analysis of published randomized controlled trials (RCTs) to compare the efficacy and tolerance of ramosetron to prevent PONV after spinal surgery.

Methods

Medline, Embase, Cochrane Library, and Science Citation Index databases were systematically searched for relevant RCT articles published between January 1979 and November 2020. Full text articles restricted to English language that described RCTs comparing the use of ramosetron with other serotonin antagonists to treat PONV following spinal surgery in adult patients were considered for meta-analysis. Two reviewers independently performed study selection, quality assessment, and data extraction of all articles. Differences were resolved by a third reviewer.

Results

The search identified 88 potentially relevant articles, of which only 3 met our selection criteria. Study drugs were administered at the end of spinal surgery in all 3 included articles. The meta-analysis revealed that ramosetron (0.3 mg) reduced the pain score (mean difference = −0.66; 95% CI −1.02 to −0.30), lowered the risk of PONV (risk ratio = 0.86; 95% CI, 0.76–0.97), and postoperative vomiting (risk ratio = 0.32; 95% CI, 0.17–0.60), and limited the use of rescue antiemetics (risk ratio = 0.66; 95% CI, 0.45–0.96) after spinal surgery. However, there were no significant differences in the incidence of postoperative nausea, the use of rescue pain medications, the number of rescue analgesics required, and the risk of discontinuation of patient-controlled analgesia between ramosetron and palonosetron (0.075 mg) or ondansetron (4 mg). There were no statistically significant differences in the risk of adverse events among the 3 medications.

Conclusions

This meta-analysis of 3 RCTs showed that ramosetron reduced the risk of PONV and POV, limited the use of rescue antiemetics, reduced the postoperative pain score, and did not increase the risk of discontinuing patient-controlled analgesia compared with palonosetron or ondansetron after spinal surgery in 3 RCTs. Therefore, this meta-analysis indicates that ramosetron is an effective and well tolerated antiemetic that can be used to prevent PONV following spinal surgery in adult patients. PROSPERO identifier: CRD42020223596 (Curr Ther Res Clin Exp. 2022; 83:XXX–XXX)

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来源期刊

Current Therapeutic Research-clinical and Experimental 医学-药学

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

3 months

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