Bhattacharjee Debamita, Doleman Brett, Lund Jonathan, Williams John
J Perianesth Nurs. 2019 Aug;34(4):680-690. doi: 10.1016/j.jopan.2018.11.006. Epub 2019 Mar 14.
Patients rank postoperative nausea and vomiting (PONV) as the most undesirable outcome of anesthesia. Mirtazapine is hypothesized to be effective in PONV prophylaxis via 5HT3 receptor antagonism.
Systematic review and meta-analysis.
We identified seven randomized controlled trials by systematically searching electronic databases that compare the efficacy of mirtazapine versus placebo or ondansetron in reducing PONV.
Mirtazapine reduced PONV overall versus placebo in three studies (risk ratio [RR] = 0.44; 95% confidence interval [CI] 0.32 to 0.62) both on conventional meta-analysis and trial sequential analysis. One study comparing mirtazapine with ondansetron found similar rates of PONV (RR = 0.96; 95% CI 0.48 to 1.94). Mirtazapine reduced preoperative anxiety versus placebo or ondansetron (standardized mean difference -1.4; 95% CI -2.56 to -0.23) but increased sedation (RR = 22.47; 95% CI 5.61 to 89.93). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality of evidence was moderate to low.
This meta-analysis suggests that mirtazapine reduces PONV overall versus placebo. We found evidence of reduction in preoperative anxiety, although mirtazapine increased the risk of sedation.
患者将术后恶心呕吐（PONV）列为麻醉最不良的后果。米氮平被认为可通过5HT3受体拮抗作用有效预防PONV。
系统评价和荟萃分析。
我们通过系统检索电子数据库，确定了7项随机对照试验，这些试验比较了米氮平与安慰剂或昂丹司琼在降低PONV方面的疗效。
在三项研究中，与安慰剂相比，米氮平总体上降低了PONV（风险比[RR]=0.44；95%置信区间[CI]0.32至0.62），无论是传统荟萃分析还是试验序贯分析均如此。一项比较米氮平与昂丹司琼的研究发现，PONV发生率相似（RR=0.96；95%CI0.48至1.94）。与安慰剂或昂丹司琼相比，米氮平降低了术前焦虑（标准化均数差-1.4；95%CI-2.56至-0.23），但增加了镇静作用（RR=22.47；95%CI5.61至89.93）。推荐分级、评估、制定与评价（GRADE）证据质量为中到低。
这项荟萃分析表明，与安慰剂相比，米氮平总体上降低了PONV。我们发现有证据表明术前焦虑有所减轻，尽管米氮平增加了镇静风险。
