摘要
目的系统评价地塞米松预防剖宫产术后采用阿片类药物镇痛所致恶心呕吐的效果。方法计算机检索Pub Med、EMbase、CNKI、Wan Fang Data和CBM数据库,检索时限均为从建库至2015年12月31日,搜集地塞米松预防剖宫产术后采用阿片类药物镇痛所致恶心呕吐的相关随机对照试验(RCT)。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入10篇文献,包含11个RCT,共1 011例患者。Meta分析结果显示:与安慰剂/空白对照比较,预防性使用地塞米松可以降低术后恶心的发生率[RR=0.50,95%CI(0.39,0.65),P<0.000 01],呕吐发生率[RR=0.39,95%CI(0.29,0.52),P<0.000 01]、恶心和呕吐(PONV)发生率[RR=0.37,95%CI(0.30,0.46),P<0.000 01],以及救援止吐治疗率[RR=0.34,95%CI(0.19,0.62),P=0.000 5]。结论预防性应用地塞米松可以有效减少剖宫产术后采用阿片类药物镇痛所致恶心和呕吐的发生。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量、大样本的RCT进行验证。
Objective To systematically review the effect of dexamethasone in preventing post-operative nausea and vomiting （PONV） associated with epidural opioids for post-cesarean section analgesia. Methods We searched PubMed, EMbase, CNKI, WanFang Data and CBM databases from inception to Dec. 3Ph 2015, to collect randomized controlled trials （RCTs） comparing dexamethasone with placebo/blank for the prevention of PONV associated with epidural opioids for post- cesarean section analgesia. Two reviewer independently screened literature, extracted data, and assess the risk of bias of induded studies. Then, meta-analysis was conducted by using RevMan 5.3 software. Results A total of 11 RCTs from 10 papers involving 1 011 patients were included. The results of meta-analysis showed that, compared with the placebo/blank group, the dexamethasone group had lower incidence rates of post-operative nausea （RR=0.50, 95%CI 0.39 to 0.65, P〈0.000 01）, post- operative vomiting （RR=0.39, 95%CI 0.29 to 0.52, P〈0.000 01）, PONV （RR=0.37, 95%CI 0.30 to 0.46, P〈0.000 01）, and rescue antiemetic （RR--0.34, 95%CI 0.19 to 0.62, P=0.000 5）. Conclusions Current evidence indicates that dexamethasone is effective for preventing PONV after epidural opioids for post-cesarean section analgesia. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
出处
《中国循证医学杂志》
CSCD
2016年第8期933-938,共6页
Chinese Journal of Evidence-based Medicine
关键词
地塞米松
剖宫产
术后恶心呕吐
系统评价
META分析
随机对照试验
Dexamethasone
Cesarean section
Postoperative nausea and vomiting
Systematic review
Meta-analysis
Randomized controlled trial
