Zhang Hongwei, Zheng Jianqiao, Zhang Lu, Du Li
Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2025 Jun 20;104(25):e42908. doi: 10.1097/MD.0000000000042908.
Postoperative nausea and vomiting (PONV) is one of the most common adverse complications associated with anesthesia and after surgical procedures. PONV is related to patient dissatisfaction and can lead to several postoperative complications. This study aimed to examine the efficacy and safety of penehyclidine combined with antiemetics in preventing PONV.
We searched English databases (including PubMed, Web of Science, Ovid Medline, Embase and Cochrane Library), Chinese electronic databases (including China National Knowledge Infrastructure, Wanfang, VIP, and Chinese Biomedical Literature) and trial registry databases to find randomized controlled trials researching the clinical validity of penehyclidine combined with antiemetics for PONV. The retrieval time was up to January 2025, without publication date restrictions. Articles published in the English and Chinese languages were considered. The primary outcome was the incidence of PONV within and over 24 hours postoperatively. The secondary outcomes were the incidence of different severities of PONV, incidence of postoperative rescue antiemetic therapy and postoperative complications. Quality assessment was conducted with the Cochrane Collaboration's risk of bias tool and grading of recommendations assessment, development and evaluation method. Subgroup analyses were performed according to the postoperative observation period. Trial sequential analysis was performed to validate the reliability of the primary outcome. Publication bias was assessed by funnel plots and Egger's regression test.
Sixteen randomized controlled trials comprising 1561 participants were included. Compared with the control group, penehyclidine combined with antiemetics provided a lower incidence of PONV (risk ratio [RR]: 0.65; 95% CI: 0.57-0.74; P < .00001; I2 = 11%; low quality), lower incidence of severe PONV over 24 hours postoperatively (RR: 0.29; 95% CI: 0.15-0.56; P = .0003; I2 = 0%; low quality), and a lower incidence of postoperative rescue antiemetic therapy (RR = 0.42, 95% CI: 0.26-0.69; P = .0006; I2 = 58%; low quality). However, it was associated with a higher incidence of dry mouth (RR: 3.10, 95% CI: 2.28-4.20; P < .00001; I2 = 19%; low quality), but did not increase the incidence of other anticholinergic-related complications (RR: 1.08; 95% CI: 0.91-1.28; P = .38; I2 = 2%; low quality).
Compared with antiemetics, penehyclidine combined with antiemetics could provide better prevention efficiency for PONV, with lower incidence of PONV, lower incidence of severe PONV over 24 hours postoperatively and lower incidence of postoperative rescue antiemetic therapy.
术后恶心呕吐（PONV）是与麻醉和外科手术后相关的最常见不良并发症之一。PONV与患者满意度相关，并可导致多种术后并发症。本研究旨在探讨戊乙奎醚联合止吐药预防PONV的有效性和安全性。
我们检索了英文数据库（包括PubMed、Web of Science、Ovid Medline、Embase和Cochrane图书馆）、中文电子数据库（包括中国知网、万方、维普和中国生物医学文献数据库）以及试验注册数据库，以查找研究戊乙奎醚联合止吐药预防PONV临床有效性的随机对照试验。检索时间截至2025年1月，无出版日期限制。纳入英文和中文发表的文章。主要结局是术后24小时内及术后24小时以上PONV的发生率。次要结局是不同严重程度PONV的发生率、术后抢救性止吐治疗的发生率和术后并发症。采用Cochrane协作网的偏倚风险工具和推荐意见评估、制定与评价方法进行质量评估。根据术后观察期进行亚组分析。进行试验序贯分析以验证主要结局的可靠性。通过漏斗图和Egger回归检验评估发表偏倚。
纳入16项随机对照试验，共1561名参与者。与对照组相比，戊乙奎醚联合止吐药使PONV发生率更低（风险比[RR]：0.65；95%置信区间：0.57 - 0.74；P <.00001；I² = 11%；低质量），术后24小时以上严重PONV的发生率更低（RR：0.29；95%置信区间：0.15 - 0.56；P =.0003；I² = 0%；低质量），术后抢救性止吐治疗的发生率更低（RR = 0.42，95%置信区间：0.26 - 0.69；P =.0006；I² = 58%；低质量）。然而，它与口干发生率较高相关（RR：3.10，95%置信区间：2.28 - 4.20；P <.00001；I² = 19%；低质量），但未增加其他抗胆碱能相关并发症的发生率（RR：1.08；95%置信区间：0.91 - 1.28；P =.38；I² = 2%；低质量）。
与止吐药相比，戊乙奎醚联合止吐药对PONV的预防效果更好，PONV发生率更低，术后24小时以上严重PONV的发生率更低，术后抢救性止吐治疗的发生率更低。
