Department of Anesthesiology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Medicine (Baltimore). 2023 Jul 21;102(29):e34385. doi: 10.1097/MD.0000000000034385.
Postoperative nausea and vomiting (PONV) is one of the common adverse reactions after surgery. Recent randomized controlled trials (RCTs) investigating antiemetic drugs suggest that aprepitant has the strongest antiemetic effect of any single drug. This meta-analysis aimed to explore the efficacy of aprepitant for preventing PONV based on the existing literature.
To identify RCTs investigating the use of aprepitant for PONV prevention, we searched PubMed, Embase, and Cochrane Library databases for articles published prior to March 20, 2022. Seventeen RCTs were identified, with 3299 patients, meeting the inclusion criteria. PONV incidence, complete response, 80 mg aprepitant combined with dexamethasone and ondansetron, vomiting, nausea, and analgesic dose-response were the main outcomes measured.
Compared with the control group, PONV incidence was significantly reduced among those receiving aprepitant (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.26, 0.44; P < .0001), with a more complete response (OR: 1.35; 95% CI: 1.14, 1.59; P = .0004). Supplementation of 80 mg aprepitant in combination with dexamethasone and ondansetron substantially improved the effects of PONV (OR: 0.36; 95% CI: 0.16, 0.82; P = .01). Further, administration of 80 mg aprepitant was better at preventing vomiting than nausea (OR: 8.6; 95% CI: 3.84, 19. 29; P < .00001). No statistically significant difference between the dose-response of analgesics was identified (mean difference: -1.09; 95% CI: -6.48, 4.30; P = .69). The risk of bias was assessed independently by paired evaluators.
Aprepitant effectively reduces the incidence of PONV; however, the effects of postoperative analgesia require further exploration.
术后恶心和呕吐（PONV）是手术后常见的不良反应之一。最近的随机对照试验（RCT）表明，阿瑞匹坦是单一药物中抗呕吐效果最强的药物。本荟萃分析旨在基于现有文献探讨阿瑞匹坦预防 PONV 的疗效。
为了确定阿瑞匹坦预防 PONV 的 RCT，我们检索了截至 2022 年 3 月 20 日的 PubMed、Embase 和 Cochrane 图书馆数据库中的文章。确定了 17 项 RCT，共 3299 例患者符合纳入标准。PONV 发生率、完全缓解、80mg 阿瑞匹坦联合地塞米松和昂丹司琼、呕吐、恶心和镇痛剂量反应是主要测量的结果。
与对照组相比，接受阿瑞匹坦治疗的患者 PONV 发生率显著降低（比值比 [OR]：0.34；95%置信区间 [CI]：0.26，0.44；P<0.0001），且完全缓解率更高（OR：1.35；95%CI：1.14，1.59；P=0.0004）。补充 80mg 阿瑞匹坦联合地塞米松和昂丹司琼可显著改善 PONV 的疗效（OR：0.36；95%CI：0.16，0.82；P=0.01）。此外，阿瑞匹坦 80mg 用于预防呕吐的效果优于预防恶心（OR：8.6；95%CI：3.84，19.29；P<0.00001）。在镇痛药的剂量反应方面，未发现统计学差异（平均差异：-1.09；95%CI：-6.48，4.30；P=0.69）。风险偏倚由配对评估者独立评估。
阿瑞匹坦能有效降低 PONV 的发生率，但术后镇痛效果尚需进一步探讨。
