Singhal A K, Kannan S, Gota V S
Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
J Postgrad Med. 2012 Jan-Mar;58(1):23-31. doi: 10.4103/0022-3859.93249.
Postoperative nausea and vomiting (PONV) are distressing adverse events following breast cancer surgery with an incidence of up to 80%. 5HT 3 antagonists are commonly employed as drugs of first choice for PONV although there is no clear evidence favoring one pharmacological approach over another.
The objective of this meta-analysis is to compare the efficacy of 5HT 3 antagonists against all non-5HT 3 antagonism-based pharmacological approaches as a preemptive strategy for PONV in women undergoing breast surgery.
Meta-analysis of Randomized Controlled Trials.
Literature search was conducted through PUBMED, reference lists, and Cochrane Central Register of Controlled Trials till June 2010 to identify eligible studies. Trials comparing 5-HT 3 antagonists with placebo or active controls for prophylaxis against PONV in women undergoing breast surgery were included. Two reviewers extracted the data independently. Methodological quality of each trial was assessed using Jadad score.
Nineteen trials were included. All trials were of good methodological quality (Jadad score >3). 5HT 3 antagonists were found superior to placebo [Odds ratio (OR)=0.18 (0.13-0.26)] or active controls [OR=0.65 (0.47-0.91)] in the prevention of PONV. 5HT 3 antagonists were also superior to placebo in preventing nausea alone [OR=0.51 (0.34-0.76)], vomiting [OR=0.31 (0.20-0.47)] and the use of rescue antiemetics [OR=0.18 (0.11-0.28)]. No significant difference was observed in the use of rescue antiemetics as compared to active controls [0.59 (0.19 to 1.86)].
5HT 3 antagonists are superior to other pharmacological interventions for the prevention of PONV in patients undergoing breast surgery under general anesthesia.
术后恶心呕吐（PONV）是乳腺癌手术后令人痛苦的不良事件，发生率高达80%。5-羟色胺3（5HT 3）拮抗剂通常被用作预防PONV的首选药物，尽管尚无明确证据表明一种药理学方法优于另一种。
本荟萃分析的目的是比较5HT 3拮抗剂与所有非基于5HT 3拮抗作用的药理学方法作为接受乳房手术女性PONV预防策略的疗效。
随机对照试验的荟萃分析。
通过PUBMED、参考文献列表和Cochrane对照试验中央注册库进行文献检索，直至2010年6月，以确定符合条件的研究。纳入了比较5-HT 3拮抗剂与安慰剂或活性对照预防接受乳房手术女性PONV的试验。两名研究者独立提取数据。使用Jadad评分评估每个试验的方法学质量。
纳入19项试验。所有试验的方法学质量都很好（Jadad评分>3）。发现5HT 3拮抗剂在预防PONV方面优于安慰剂[比值比（OR）=0.18（0.13 - 0.26）]或活性对照[OR=0.65（0.47 - 0.91）]。5HT 3拮抗剂在单独预防恶心[OR=0.51（0.34 - 0.76）]、呕吐[OR=0.31（0.20 - 0.47）]和使用补救性止吐药[OR=0.18（0.11 - 0.28）]方面也优于安慰剂。与活性对照相比，在使用补救性止吐药方面未观察到显著差异[0.59（0.19至1.86）]。
在全身麻醉下接受乳房手术的患者中，5HT 3拮抗剂在预防PONV方面优于其他药理学干预措施。
