Eizadi-Mood Nastaran, Ghandehari Maliheh, Mansourian Marjan, Sabzghabaee Ali Mohammad, Samasamshariat Shiva, Sadeghi Erfan
Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Prev Med. 2019 Oct 9;10:183. doi: 10.4103/ijpvm.IJPVM_268_18. eCollection 2019.
Many studies have focused on the relationship between naloxone and seizure in tramadol poisoning but the results are in conflict. We performed a meta-analysis study to see whether naloxone prevents or increase the risk of seizure in tramadol poisoning.
Bibliographic literature searches were conducted in the ISI Web of Science, Excerpta Medica Database (EMBASE), PubMed, and Cochrane from January 1990 to December 2017 for relevant articles. Pooled data were analyzed by calculating odds ratios (ORs) with 95% confidence intervals (CIs). The outcome includes seizure. To investigate the publication bias, Begg's and Egger's tests were used along with funnel plot as a graphical test.
Seven studies met the inclusion criteria. The meta-analysis showed , 27%, ( value, 0.23) indicating no significant heterogeneity. As a result, using the fixed effect, the OR was 1.14 (95% CI = 0.60-2.18, value, 0.69) which was not significant, means naloxone did not increase the risk of seizure.
Naloxone therapy did not increase the risk of seizure significantly in the treatment of acute tramadol poisoning. We suggest considering the risk/benefit when administration naloxone, especially for the seizure risk factors including previous history of seizure, tramadol misuse, and co-ingestion.
许多研究聚焦于纳洛酮与曲马多中毒时癫痫发作之间的关系，但结果存在冲突。我们进行了一项荟萃分析研究，以观察纳洛酮在曲马多中毒时是否会预防或增加癫痫发作风险。
于1990年1月至2017年12月在科学引文索引（ISI）科学网、医学文摘数据库（EMBASE）、PubMed和考克兰系统评价数据库中进行文献检索，查找相关文章。通过计算比值比（OR）及95%置信区间（CI）对汇总数据进行分析。结局指标包括癫痫发作。为调查发表偏倚，使用了Begg检验和Egger检验，并绘制漏斗图作为图形检验。
七项研究符合纳入标准。荟萃分析显示 ，27%，（ 值，0.23），表明无显著异质性。因此，采用固定效应模型，OR为1.14（95%CI = 0.60 - 2.18， 值，0.69），无统计学意义，这意味着纳洛酮并未增加癫痫发作风险。
在急性曲马多中毒治疗中，纳洛酮治疗并未显著增加癫痫发作风险。我们建议在使用纳洛酮时考虑风险/获益，尤其是对于存在癫痫发作危险因素的患者，包括有癫痫发作既往史、曲马多滥用及合并用药情况。
