背景:选择性5-羟色胺3受体(5-HT3)拮抗剂通常用于预防剖宫产后的恶心和呕吐(NV),但不同5-HT3拮抗剂的疗效比较尚不清楚.该网络荟萃分析旨在确定在脊髓麻醉下择期剖宫产的产妇中,哪些5-HT3拮抗剂可能是预防NV的首选。
方法:PubMed,EMBASE,科克伦图书馆,和WebofScience检索了2023年8月24日前发表的相关随机对照试验(RCT).使用Stata14.0进行随机网络荟萃分析,以评估不同5-HT3拮抗剂预防术中和术后NV的功效。
结果:包括28项研究,涉及三种5-HT3拮抗剂的7种给药方案。汇总结果显示,昂丹司琼12mg在预防术后NV(PONV)方面优于其他6种给药方案,PON,和POV,排名概率为80.2%,95.8%,和87.7%,分别,其次是格拉司琼2毫克。昂丹司琼4mg可能是预防术中NV(IONV)的首选药物(92.8%),术后抢救用止吐药者最少(90.6%)。格拉司琼3毫克和托烷司琼2毫克可能是预防ION和IOV的最佳选择,分别。
结论:根据现有数据,昂丹司琼12毫克可能具有预防PONV的最佳疗效,PON,和POV。此外,需要更多的研究来比较12mg昂丹司琼与2mg格拉司琼的安全性.
Selective 5-hydroxytryptamine 3 receptor (5-HT3) antagonists are commonly used to prevent nausea and vomiting (NV) after cesarean section, but the comparative efficacy of different 5-HT3 antagonists remains unclear. This network meta-analysis aimed to determine which 5-HT3 antagonists might be the preferred choice for preventing NV in parturient scheduled for elective cesarean delivery under spinal anesthesia.
PubMed, EMBASE, Cochrane library, and Web of Science were searched for relevant randomized controlled trials (RCTs) published before August 24, 2023. Random network meta-analysis was performed using Stata 14.0 to estimate the efficacy of different 5-HT3 antagonists in preventing intra- and post-operative NV.
Twenty-eight studies involving seven dosing regimens of three 5-HT3 antagonists were included. Pooled results showed that
ondansetron 12 mg was superior to other six dosing regimens in the prevention of postoperative NV (PONV), PON, and POV, with the ranking probability of 80.2%, 95.8%, and 87.7%, respectively, followed by granisetron two mg.
Ondansetron 4 mg might be the first choice for preventing intraoperative NV (IONV) (92.8%), with the least use of postoperative rescue antiemetics (90.6%). Granisetron 3 mg and tropisetron 2 mg might be the best options for preventing ION and IOV, respectively.
Based on available data,
ondansetron 12 mg may have the best efficacy in preventing PONV, PON, and POV. Additionally, more studies are warranted to compare the safety of
ondansetron 12 mg versus granisetron two mg.