昂丹司琼预防椎管内使用阿片类药物所致瘙痒的系统评价_《中国循证医学杂志》

作者：

杜宇 , 柳慧 ,  林雪梅

四川大学华西第二医院麻醉科（成都 610041）;

关键词：

椎管内麻醉昂丹司琼阿片类药物随机对照试验系统评价 Meta分析

DOI：

10.7507/1672-2531.20120094

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价昂丹司琼对椎管内使用阿片类药物导致皮肤瘙痒的预防作用。
方法　采用Cochrane系统评价方法，计算机检索Cochrane Library、OVID、EMbase、PubMed、CNKI、CBM等数据库，收集与昂丹司琼预防椎管内使用阿片类药物导致瘙痒相关的随机对照试验（RCT），按纳入和排除标准筛选文献、提取资料和评价质量后，采用RevMan 5.0软件进行Meta分析。
结果　共纳入8个RCT，577例患者。文献质量评价结果显示所有研究偏倚均不确定。由于纳入研究间异质性过大（P=0.000 1，I2=80%），故按不同手术方式进行亚组分析。Meta分析结果显示：对于泌尿和关节外科及妇科手术，昂丹司琼组与对照组瘙痒发生率的差异有统计学意义［泌尿和关节外科手术：RR=0.49，95%CI（0.35，0.67）；妇科手术RR=0.51，95%CI（0.34，0.76）］；而对于产科及门诊手术，昂丹司琼组与对照组瘙痒发生率的差异无统计学意义［产科手术：RR=0.98，95%CI（0.86，1.12）；门诊手术：RR=0.49，95%CI（0.35，0.67）］。
结论　本系统评价结果提示：昂丹司琼对泌尿、关节和妇科手术中使用阿片类药物所致皮肤瘙痒有预防作用，而对产科和门诊手术中使用阿片类药物所致皮肤瘙痒无预防作用。但由于纳入研究数量少，样本量小，异质性较大，且偏倚风险不确定，故以上结论尚待进一步开展更多高质量RCT加以验证。

引用本文： 杜宇,柳慧,林雪梅. 昂丹司琼预防椎管内使用阿片类药物所致瘙痒的系统评价. 中国循证医学杂志, 2012, 12(5): 583-588. doi: 10.7507/1672-2531.20120094 复制

1.	Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus propofol for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2001, 93(1): 162-165.
2.	Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
3.	Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2003, 96(6): 1789-1793.
4.	Kjellberg F, Tramer MR. Pharmacological control of opioid-induced pruritus: a quantitative system atic review of randomized trials. Eur J Anaesthesiol, 2001, 18(6): 346-357.
5.	Hindle AT. Recent developments in the physiology and pharmacology of 5-hydroxytryptamine. Br J Aanesth, 1994, 73(3): 395-407.
6.	Raderer M, Muller C, Scheithauer W. Ondansetron for pruritus due to cholestasis. N Engl J Med, 1994, 330(21): 1540.
7.	Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.[updated March 2011], The Cochrane Collaboration, 2011. Available from: URL: http://www.cochrane-handbook.org.
8.	Waxler B, Mondragon SA, Patel SN, et al. Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil. Can J Anesth, 2004, 51(7): 685-689.
9.	Sarvela PJ, Halonen PM, Soikkeli AI, et al. Ondansetron and tropisetron do not prevent intraspinal morphine and fentanyl-induced pruritus in elective cesarean delivery. Acta Anaesthesiol Scand, 2006, 50(2): 239-244.
10.	Wells J, Paech MJ, Evans SF. Intrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron. Int J Obstet Anesth, 2004, 13(1): 35-39.
11.	Siddik-Sayyid SM, Aouad MT, Taha SK, et al. Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery? Anesth Analg, 2007, 104(2): 421-424.
12.	Tzeng JI, Chu KS, Ho ST, et al. Prophylactic iv ondansetron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control. Can J Anesth, 2003, 50(10): 1023-1026.
13.	Iatrou CA, Dragoumanis CK, Vogiatzaki TD, et al. Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study. Anesth Analg, 2005, 101(5): 1516-1520.
14.	王丽秋, 郭亚忠, 陶玉娟. 昂丹司琼对蛛网膜下腔使用吗啡导致的皮肤瘙痒的预防作用. 中国伤残医学, 2009, 17(4): 11-12.
15.	Yavuz G, Kamil T. Prophylactic Ondansetron Reduces the Incidence of Intrathecal Fentanyl-Induced Pruritus. Anesth Analg, 2002, 95(2): 1763-1766.
16.	Mulroy MF, Larkin KL, Siddiqui A. Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine. Reg Anesth Pain Med, 2001, 26(3): 252-256.
17.	Shah MK, Sia AT, Chong JL. The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labor. Anaesthesia, 2000, 55(10): 1008-1013.
18.	Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
19.	Kyriakides K, Hussain SK, Hobbs GJ. Management of opioid-induced pruritus: a role for 5-HT3 antagonists? Br J Anaesth, 1999, 82(3): 439-441.
20.	Ikoma A, Rukwied R, Stander S, et al. Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol, 2003, 139(11): 1475-1478.

1. Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus propofol for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2001, 93(1): 162-165.
2. Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
3. Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2003, 96(6): 1789-1793.
4. Kjellberg F, Tramer MR. Pharmacological control of opioid-induced pruritus: a quantitative system atic review of randomized trials. Eur J Anaesthesiol, 2001, 18(6): 346-357.
5. Hindle AT. Recent developments in the physiology and pharmacology of 5-hydroxytryptamine. Br J Aanesth, 1994, 73(3): 395-407.
6. Raderer M, Muller C, Scheithauer W. Ondansetron for pruritus due to cholestasis. N Engl J Med, 1994, 330(21): 1540.
7. Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.[updated March 2011], The Cochrane Collaboration, 2011. Available from: URL: http://www.cochrane-handbook.org.
8. Waxler B, Mondragon SA, Patel SN, et al. Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil. Can J Anesth, 2004, 51(7): 685-689.
9. Sarvela PJ, Halonen PM, Soikkeli AI, et al. Ondansetron and tropisetron do not prevent intraspinal morphine and fentanyl-induced pruritus in elective cesarean delivery. Acta Anaesthesiol Scand, 2006, 50(2): 239-244.
10. Wells J, Paech MJ, Evans SF. Intrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron. Int J Obstet Anesth, 2004, 13(1): 35-39.
11. Siddik-Sayyid SM, Aouad MT, Taha SK, et al. Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery? Anesth Analg, 2007, 104(2): 421-424.
12. Tzeng JI, Chu KS, Ho ST, et al. Prophylactic iv ondansetron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control. Can J Anesth, 2003, 50(10): 1023-1026.
13. Iatrou CA, Dragoumanis CK, Vogiatzaki TD, et al. Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study. Anesth Analg, 2005, 101(5): 1516-1520.
14. 王丽秋, 郭亚忠, 陶玉娟. 昂丹司琼对蛛网膜下腔使用吗啡导致的皮肤瘙痒的预防作用. 中国伤残医学, 2009, 17(4): 11-12.
15. Yavuz G, Kamil T. Prophylactic Ondansetron Reduces the Incidence of Intrathecal Fentanyl-Induced Pruritus. Anesth Analg, 2002, 95(2): 1763-1766.
16. Mulroy MF, Larkin KL, Siddiqui A. Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine. Reg Anesth Pain Med, 2001, 26(3): 252-256.
17. Shah MK, Sia AT, Chong JL. The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labor. Anaesthesia, 2000, 55(10): 1008-1013.
18. Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
19. Kyriakides K, Hussain SK, Hobbs GJ. Management of opioid-induced pruritus: a role for 5-HT3 antagonists? Br J Anaesth, 1999, 82(3): 439-441.
20. Ikoma A, Rukwied R, Stander S, et al. Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol, 2003, 139(11): 1475-1478.

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昂丹司琼预防椎管内使用阿片类药物所致瘙痒的系统评价

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《中国循证医学杂志》

昂丹司琼预防椎管内使用阿片类药物所致瘙痒的系统评价

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