Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea.
Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
Medicine (Baltimore). 2024 Jun 7;103(23):e38334. doi: 10.1097/MD.0000000000038334.
Traditionally, herbal medicines have been used to alleviate nausea and vomiting; however, a comprehensive clinical evaluation for postoperative nausea and vomiting (PONV), especially after laparoscopic surgery, remains limited. This review aimed to evaluate the efficacy and safety of herbal medicine as an alternative therapy to prevent and manage nausea and vomiting after laparoscopic surgery compared with untreated, placebo, and Western medicine groups.
We searched 11 databases, including EMBASE, PubMed, and the Cochrane Library, to collect randomized controlled trials (RCTs) of herbal medicines on PONV after laparoscopic surgery on July 7, 2022. Two independent reviewers screened and selected eligible studies, extracted clinical data, and evaluated the quality of evidence using the Cochrane risk-of-bias tool. The primary outcome was the incidence of PONV, whereas the secondary outcomes included the frequency and intensity of PONV, symptom improvement time, antiemetic requirement frequency, and incidence of adverse events. Review Manager Version 5.3. was used for the meta-analysis.
We identified 19 RCTs with 2726 participants comparing herbal medicine with no treatment, placebo, and Western medicine. The findings showed that compared with no treatment, herbal medicine demonstrated significant effects on vomiting incidence (risk ratio [RR] = 0.43, 95% confidence interval [CI] 0.32-0.57, P < .00001). Compared with placebo, herbal medicine revealed a significant effect on the severity of nausea 12 hours after laparoscopic surgery (standardized mean difference = -2.04, 95% CI -3.67 to -0.41, P = .01). Herbal medicines showed similar effects with Western medicine on the incidence of postoperative nausea (RR = 0.94, 95% CI 0.63-1.42, P = .77) and vomiting (RR = 0.68, 95% CI 0.25-1.84, P = .45). Furthermore, comparing the experimental group containing herbal medicine and control group excluding herbal medicine, adverse events were considerably lower in the group with herbal medicine (RR = 0.45, 95% CI 0.27-0.72, P = .001).
Herbal medicine is an effective and safe treatment for nausea and vomiting secondary to laparoscopic surgery. However, the number of studies was small and their quality was not high; thus, more well-designed RCTs are warranted in the future.
传统上，草药被用于缓解恶心和呕吐；然而，对于术后恶心和呕吐（PONV），特别是腹腔镜手术后的恶心和呕吐，全面的临床评估仍然有限。本综述旨在评估草药作为替代疗法预防和治疗腹腔镜手术后恶心和呕吐的疗效和安全性，与未治疗、安慰剂和西药组进行比较。
我们于 2022 年 7 月 7 日检索了包括 EMBASE、PubMed 和 Cochrane 图书馆在内的 11 个数据库，以收集关于腹腔镜手术后 PONV 的草药的随机对照试验（RCT）。两名独立的审查员筛选并选择合格的研究，提取临床数据，并使用 Cochrane 偏倚风险工具评估证据质量。主要结局是 PONV 的发生率，次要结局包括 PONV 的频率和强度、症状改善时间、止吐药需求频率和不良事件的发生率。使用 Review Manager Version 5.3 进行荟萃分析。
我们确定了 19 项 RCT，涉及 2726 名参与者，比较了草药与无治疗、安慰剂和西药。研究结果表明，与无治疗相比，草药在呕吐发生率方面有显著效果（风险比[RR] = 0.43，95%置信区间[CI] 0.32-0.57，P <.00001）。与安慰剂相比，草药在腹腔镜手术后 12 小时对恶心严重程度有显著效果（标准化均数差 = -2.04，95% CI -3.67 至 -0.41，P =.01）。草药在术后恶心（RR = 0.94，95% CI 0.63-1.42，P =.77）和呕吐（RR = 0.68，95% CI 0.25-1.84，P =.45）方面与西药的效果相似。此外，在包含草药的实验组和不包含草药的对照组之间进行比较，草药组的不良事件明显较低（RR = 0.45，95% CI 0.27-0.72，P =.001）。
草药是腹腔镜手术后恶心和呕吐的有效且安全的治疗方法。然而，研究数量较少，质量不高；因此，未来需要更多设计良好的 RCT。
