Zhong Wei-Guo, Ge Xin-Yu, Zhu Hai, Liang Xiao, Gong Hong-Xia, Zhong Ming, Xiao Xiang
Department of Obstetrics, Shanghai Changning District Maternity and Infant Health Hospital Changning District, Shanghai 200051, P. R. China.
Hebei North University, School of Medicine P. R. China ; Department of Anesthesiology, Changzheng Hospital, Second Military Medical University Huangpu District, Shanghai 200003, P. R. China.
Int J Clin Exp Med. 2015 Sep 15;8(9):14566-76. eCollection 2015.
Postoperative nausea and vomiting (PONV) is a common complication after gynecological surgeries. This meta-analysis was conducted to evaluate the efficacy of dexmedetomidine on PONV after gynecological surgeries.
Three main electronic databases including Pub Med, Embase and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) were searched by two researchers independently. The metaanalysis was completed using Review Manager.
Eleven RCTs with 692 patients were included in this metaanalysis. Dexmedetomidine a bridged postoperative nausea [Risk Ratio (RR)=0.59, 95% confidence interval (CI): 0.44 to 0.79] and vomiting [RR=0.48, 95% CI: 0.36 to 0.64] compared with placebo. Despite of higher incidence of intra operative bradycardia [RR 2.87, 95% CI 1.08 to 7.58] and hypotension [RR 4.26, 95% CI 1.43 to 12.69], we found significant decrease in postoperative shivering [RR 0.23, 95% CI 0.13 to 0.40] and pruritus [RR 0.40, 95% CI 0.17 to 0.93] in dexmedetomidine group, as well as the pain scores [standard mean difference (SMD)-0.96, 95% CI-1.37 to-0.54]. Significant reductions in the need for intraoperative fentanyl (RR 0.10, 95% CI 0.01-0.76, I(2) 0%), antiemetic (RR 0.62, 95% CI 0.39-0.99, I(2) 0%) and postoperative analgesic (RR 0.18, 95% CI 0.08-0.42, I(2) 0%) were also elicited.
The current meta-analysis exhibits that dexmedetomidine is superiority to placebo in attenuating the incidence of PONV, postoperative shivering, pruritus, as well as the pain scores in patients undergoing gynecological surgeries. Still, the potential cardiovascular complications should be taken seriously.
术后恶心呕吐（PONV）是妇科手术后常见的并发症。本荟萃分析旨在评估右美托咪定对妇科手术后PONV的疗效。
两名研究人员独立检索了三个主要电子数据库，包括Pub Med、Embase和Cochrane对照试验中央注册库中的随机对照试验（RCT）。使用Review Manager完成荟萃分析。
本荟萃分析纳入了11项RCT，共692例患者。与安慰剂相比，右美托咪定可减轻术后恶心[风险比（RR）=0.59，95%置信区间（CI）：0.44至0.79]和呕吐[RR=0.48，95%CI：0.36至0.64]。尽管术中心动过缓[RR 2.87，95%CI 1.08至7.58]和低血压[RR 4.26，95%CI 1.43至12.69]的发生率较高，但我们发现右美托咪定组术后寒战[RR 0.23，95%CI 0.13至0.40]、瘙痒[RR 0.40，95%CI 0.17至0.93]以及疼痛评分[标准平均差（SMD）-0.96，95%CI-1.37至-0.54]均显著降低。术中芬太尼需求（RR 0.10，95%CI 0.01-0.76，I²0%）、止吐药需求（RR 0.62，95%CI 0.39-0.99，I²0%）和术后镇痛药需求（RR 0.18，95%CI 0.08-0.42，I²0%）也显著减少。
当前的荟萃分析表明，右美托咪定在降低妇科手术患者PONV发生率、术后寒战、瘙痒以及疼痛评分方面优于安慰剂。尽管如此，仍应重视潜在的心血管并发症。
