昂丹司瓊預防椎管內使用阿片類藥物所致瘙癢的系統評價_《中國循證醫學雜志》

作者：

杜宇 , 柳慧 ,  林雪梅

四川大學華西第二醫院麻醉科（成都 610041）;

關鍵詞：

椎管內麻醉昂丹司瓊阿片類藥物隨機對照試驗系統評價 Meta分析

DOI：

10.7507/1672-2531.20120094

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目的　系統評價昂丹司瓊對椎管內使用阿片類藥物導致皮膚瘙癢的預防作用。
方法　采用Cochrane系統評價方法，計算機檢索Cochrane Library、OVID、EMbase、PubMed、CNKI、CBM等數據庫，收集與昂丹司瓊預防椎管內使用阿片類藥物導致瘙癢相關的隨機對照試驗（RCT），按納入和排除標準篩選文獻、提取資料和評價質量后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入8個RCT，577例患者。文獻質量評價結果顯示所有研究偏倚均不確定。由于納入研究間異質性過大（P=0.000 1，I2=80%），故按不同手術方式進行亞組分析。Meta分析結果顯示：對于泌尿和關節外科及婦科手術，昂丹司瓊組與對照組瘙癢發生率的差異有統計學意義［泌尿和關節外科手術：RR=0.49，95%CI（0.35，0.67）；婦科手術RR=0.51，95%CI（0.34，0.76）］；而對于產科及門診手術，昂丹司瓊組與對照組瘙癢發生率的差異無統計學意義［產科手術：RR=0.98，95%CI（0.86，1.12）；門診手術：RR=0.49，95%CI（0.35，0.67）］。
結論　本系統評價結果提示：昂丹司瓊對泌尿、關節和婦科手術中使用阿片類藥物所致皮膚瘙癢有預防作用，而對產科和門診手術中使用阿片類藥物所致皮膚瘙癢無預防作用。但由于納入研究數量少，樣本量小，異質性較大，且偏倚風險不確定，故以上結論尚待進一步開展更多高質量RCT加以驗證。

引用本文： 杜宇,柳慧,林雪梅. 昂丹司瓊預防椎管內使用阿片類藥物所致瘙癢的系統評價. 中國循證醫學雜志, 2012, 12(5): 583-588. doi: 10.7507/1672-2531.20120094 復制

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.	王麗秋, 郭亞忠, 陶玉娟. 昂丹司瓊對蛛網膜下腔使用嗎啡導致的皮膚瘙癢的預防作用. 中國傷殘醫學, 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. 王麗秋, 郭亞忠, 陶玉娟. 昂丹司瓊對蛛網膜下腔使用嗎啡導致的皮膚瘙癢的預防作用. 中國傷殘醫學, 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.

《中國循證醫學雜志》

昂丹司瓊預防椎管內使用阿片類藥物所致瘙癢的系統評價

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《中國循證醫學雜志》

昂丹司瓊預防椎管內使用阿片類藥物所致瘙癢的系統評價

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