5-羟色胺受体拮抗剂用于剖宫产患者鞘注吗啡后瘙痒和恶心呕吐的预防与治疗：系统回顾和荟萃分析  

作　　者：Ronald B. George Terrence K. Allen Ashraf S. Habib 马兢(译) 陈畅(译) 王焱林(校) 

机构地区：[1]Department of Women's and Obstetric Anesthesia, IWK Health Centre, Dalhousie University,Halifax, Nova Scotia, Canada and ＊Department of Anesthesiology, Division of Women's Anesthesia,Duke University Medical Center, Durham, North Carolina [2]不详

出　　处：《麻醉与镇痛》2012年第4期13-22,共10页Anesthesia & Analgesia

摘　　要：背景5-羟色胺受体拮抗剂用于剖宫产患者鞘内吗啡镇痛后瘙痒和恶心呕吐的预防和治疗，本文对其总体疗效进行了系统回顾。方法本文对一系列有关剖宫产患者应用任何一种5-羟色胺受体拈抗剂或安慰剂以预防和治疗瘙痒、恶心、呕吐的随机对照研究进行了回顾分析。所涉及的文章均真实有效，资料均由作者独立收集并以95％可信区间的相对危险度（relativerisks，RR）概括。结果本综述包括9项随机对照研究，涉及1152例患者，其中539例接受5-羟色胺受体拮抗剂治疗，413例接受安慰剂治疗，另外200例患者因接受其他止吐药治疗而未参与分析。与安慰剂组相比，5-羟色胺受体拮抗剂组瘙痒发生率并未降低[80．7％VS85．8％，RR（95％CI）=0．94（0．81—1．09）]，然而5-羟色胺受体拮抗剂的应用降低了剧烈瘙痒发生率和瘙痒的治疗需求[需治疗数（number-needed-to—treat，NNT）分别为12和15]。5-羟色胺受体拮抗剂对于已出现的瘙痒疗效强于安慰剂，NNT差别为3。5-羟色胺受体拈抗剂组与安慰剂组相比，术后恶心[22．0％VS33．6％，RR（95％CI）=0．75（0．58。0．96）]和呕吐[7．7％VS16．8％，RR（95％CI）=0．49（0．30—0．81）]的发生率显著降低，术后需应用5．羟色胺受体拮抗剂进行补救性止吐治疗的发生率也明显降低[9％VS23％，RR（95％CI）=0．38（0．21—0．68）]。结论剖宫产的产妇鞘内给予吗啡镇痛，尽管预防性应用5一羟色胺受体拈抗剂不能降低瘙痒的发生率，但是却明显降低了剧烈瘙痒和需要治疗的瘙痒、术后恶心和呕吐的发生率以及术后补救性止吐治疗的需要。对于已发生的瘙痒治疗也同样有效。虽然需更多的研究加以证实，但目前的研究资料表明，在这类患者群体中常规预防性使用此类药物是值得推崇的。BACKGROUND： We performed a systematic review to determine the overall efficacy of serotonin （5-HT3 ） receptor antagonists for the prevention and treatment of pruritus, nausea, and vomiting in women receiving spinal anesthesia with intrathecal morphine for cesarean delivery. METHODS： Reports of randomized, controlled trials that compared prophylaxis ortreatment of pruritus and/or nausea, and vomiting using one of the 5-HT3 receptorantagonists or placebo in women undergoing cesarean delivery were reviewed. Theartides were scored for validity and data were extracted by the authors independentlyand summarized using relative risks （RR） with 95% confidence intervals （CI）. RESULTS： Nine randomized, controlled trials were included in the systematic review. The nine trials had a total of 1152 patients enrolled; 539 received 5- HT3 receptor antagonists, 413 received placebo, and 200 received other antiemetics and were not included in the analysis. The incidence of pruritus was not reduced with 5-HT3 receptor antagonists prophylaxis compared with placebo （80. 7% vs 85.8%, RR [95% CI] 0.94 [0. 81 -1.09] ）. However, their use reduced the incidence of severe pruritus and the need for treatment of pruritus （number-needed-to-treat = 12 and 15, respectively）. Their use for the treatment of established pruritus showed improved efficacy compared with placebo with a number-needed-to-treat of three. There was a significant reduction in the incidence of postoperative nausea （22.0% vs 33.6%, RR ~95% CI] = 0. 75 E0.58 -0.96]） and vomiting （7.7% vs 16. 8%, RR [ 95% CI ] = 0.49 [ 0.30 -0. 81 ] ）, and the need for postoperative rescue antiemetic treatment with the use of 5-HT3 receptorantagonists when compared with placebo （9% vs 23%, RR [ 95% CI ] = 0.38 [ 0. 21 - 0. 68 ] ）. CONCLUSIONS： Although prophylactic 5-HT3 receptor antagonists were ineffective in reducing the inddence of pruritus, they significantly reduced the severity and the need for treatment of pruritus, the incidence of postoperative

关 键 词：5-羟色胺受体拮抗剂 瘙痒发生率 预防性应用 患者群体 恶心呕吐 吗啡镇痛 系统回顾 剖宫产 

分 类 号：R730.53[医药卫生—肿瘤]