昂丹司琼预防椎管内使用阿片类药物所致瘙痒的系统评价  

Effects of Prophylactic Ondansetron for Preventing Intrathecal Opioid-induced Pruritus:A Systematic Review

作　　者：杜宇[1] 柳慧[1] 林雪梅[1] 

机构地区：[1]四川大学华西第二医院麻醉科,成都610041

出　　处：《中国循证医学杂志》2012年第5期583-588,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价昂丹司琼对椎管内使用阿片类药物导致皮肤瘙痒的预防作用。方法采用Cochrane系统评价方法,计算机检索Cochrane Library、OVID、EMbase、PubMed、CNKI、CBM等数据库,收集与昂丹司琼预防椎管内使用阿片类药物导致瘙痒相关的随机对照试验(RCT),按纳入和排除标准筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入8个RCT,577例患者。文献质量评价结果显示所有研究偏倚均不确定。由于纳入研究间异质性过大(P=0.0001,I2=80%),故按不同手术方式进行亚组分析。Meta分析结果显示:对于泌尿和关节外科及妇科手术,昂丹司琼组与对照组瘙痒发生率的差异有统计学意义[泌尿和关节外科手术:RR=0.49,95%CI(0.35,0.67);妇科手术RR=0.51,95%CI(0.34,0.76)];而对于产科及门诊手术,昂丹司琼组与对照组瘙痒发生率的差异无统计学意义[产科手术:RR=0.98,95%CI(0.86,1.12);门诊手术:RR=0.49,95%CI(0.35,0.67)]。结论本系统评价结果提示:昂丹司琼对泌尿、关节和妇科手术中使用阿片类药物所致皮肤瘙痒有预防作用,而对产科和门诊手术中使用阿片类药物所致皮肤瘙痒无预防作用。但由于纳入研究数量少,样本量小,异质性较大,且偏倚风险不确定,故以上结论尚待进一步开展更多高质量RCT加以验证。Objective To evaluate the effects of prophylactic ondansetron for preventing intrathecal opioid induced pruritus.Methods According to the Cochrane Handbook,such databases as The Cochrane Library,OVID,EMbase,PubMed,CNKI and CBM were searched to collect the randomized controlled trials（RCTs） about ondansetron for preventing intrathecal opioid induced pruritus.According to the predefined inclusion and exclusion criteria,the literatures were screened,and meta-analysis was conducted by using RevMan 5.0 software.Results Eight RCTs involving 577 patients were included.The quality evaluation showed the bias of all studies was unclear.Meta-analysis showed that because the heterogeneity of the included studies was so large（P=0.0001,I2=80%）,subgroup analyses were performed.The subgroup analyses on surgery methods showed no statistical heterogeneity among all subgroups.a） There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in arthroscopic knee or urologic surgery（RR=0.49,95%CI 0.35 to 0.67）;b） There was no significant difference in incidence rate of pruritus between the ondansetron group and the control group in obstetric surgery（RR=0.98,95%CI 0.86 to 1.12）;c） There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in gynecologic surgery（RR=0.51,95%CI 0.34 to 0.76）;and d） There was no significant difference in the incidence rate of pruritus between the ondansetron group and the control group in outpatient surgery（RR=0.49,95%CI 0.35 to 0.67）.Conclusion The subgroup analyses performed because of the large heterogeneity of the included studies indicate that ondansetron can prevent the intrathecal opioid induced pruritus in arthroscopic knee,urologic and gynecological surgeries rather than obstetric and outpatient surgeries.Due to the small scale,large heterogeneity and unclear quality evaluation of the included studies,more high quality RCTs are required to provide reliabl

关 键 词：椎管内麻醉 昂丹司琼 阿片类药物 随机对照试验 系统评价 Meta分析 

分 类 号：R614[医药卫生—麻醉学]