5-羥色胺受體拮抗劑預防丙泊酚注射痛有效性和安全性的Meta分析_《中國循證醫學雜志》

作者：

李淑英 ,  王曉

四川大學華西醫院麻醉科（成都 610041）;

關鍵詞：

5-羥色胺受體拮抗劑丙泊酚注射痛系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130078

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目的　系統評價5-羥色胺（5-HT3）受體拮抗劑預防丙泊酚注射痛的有效性和安全性。
方法　計算機檢索PubMed、EMbase、The Cochrane Library（2012年第1期）、CNKI、CBM、VIP和WanFang Data，查找有關5-HT3受體拮抗劑預防丙泊酚注射痛的隨機對照試驗（RCT），檢索時限均從建庫至2012年9月。由2位研究人員按照納入和排除標準獨立篩選文獻、提取資料和評價質量后，然后采用RevMan 5.2軟件進行Meta分析。
結果　最終納入15個RCT，共1 413例患者。Meta分析結果顯示：① 5-HT3組丙泊酚注射痛發生率明顯小于對照組［RR=0.14，95%CI（0.09，0.21），P lt;0.000 01］；② 在疼痛程度方面，兩組輕度注射痛差異無統計學意義［RR=0.84，95%CI（0.56，1.26），P=0.39］；5-HT3組丙泊酚中度注射痛［RR=0.25，95%CI（0.19，0.34），P lt;0.000 01］和重度注射痛的發生率［RR=0.16，95%CI（0.10，0.24），P lt;0.000 01］均明顯低于對照組。③ 在術后不良反應方面，5-HT3組術后惡心和嘔吐［RR=0.19，95%CI（0.11，0.34），P lt;0.000 01］及寒顫［RR=0.20，95%CI（0.12，0.33），P lt;0.000 01］的發生率均明顯少于對照組。
結論　5-HT3受體拮抗劑能有效預防丙泊酚注射痛，且能減輕丙泊酚注射的疼痛程度和術后不良反應發生率。受納入研究的數量和質量限制，上述結論尚待開展更多高質量研究加以驗證。

引用本文： 李淑英,王曉. 5-羥色胺受體拮抗劑預防丙泊酚注射痛有效性和安全性的Meta分析. 中國循證醫學雜志, 2013, 13(4): 452-460. doi: 10.7507/1672-2531.20130078 復制

1.	Agarwal A, Ansari M, Gupta D, et al. Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection. Anesth Analg, 2004, 98 (3): 683-686.
2.	Habib AS, Gsn TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth, 2004, 51(4): 326-341.
3.	Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth, 2001, 47(10): 1008-1018.
4.	劉啟敏, 周建敏, 鄒筱萌, 等. 昂丹司瓊聯合小劑量舒芬太尼預防異丙酚注射痛的臨床觀察. 海峽藥學, 2011, 23(4): 114-115.
5.	朱明. 昂丹司瓊與利多卡因預防異丙酚注射痛的對照研究. 山西醫藥雜志, 2012, 41(3): 263-265.
6.	嚴映霞, 牟鎮, 伍智慧. 低溫﹑昂丹司瓊﹑利多卡因單用和合用對丙泊酚注射痛的防治比較.中國社區醫師·醫學專業, 2011, 13(32): 175-176.
7.	陸宏. 靜脈注射昂丹司瓊對丙泊酚注射痛的預防作用. 牡丹江醫學院學報, 2011, 32(5): 39-40.
8.	曹東航, 丁進峰, 王明倉, 等. 利多卡因和恩丹西酮減輕異丙酚注射痛的效果比較. 現代醫藥衛生, 2005, 21(19): 2578-2579.
9.	馬玉姍, 林雪梅, 周俊. 格拉司瓊復合利多卡因減輕異丙酚注射痛的隨機雙盲對照研究. 四川大學學報(醫學版), 2009, 40(3): 536-538.
10.	傅海青. 格拉司瓊復合利多卡因靜脈預處理減輕異丙酚所致注射痛和嘔吐的臨床觀察. 中國藥房, 2010, 21(16): 1476-1478.
11.	劉楓, 葛衡江, 周蓉. 托烷司瓊對丙泊酚靜脈注射痛的預防作用. 中國醫院藥學雜志, 2006, 26(2): 192-193.
12.	邵麗麗, 呂黃偉, 田阿勇. 托烷司瓊復合利多卡因預防丙泊酚注射痛的療效觀察. 中國血液流變學雜志, 2011, 21(2): 284-286.
13.	涂昕祥. 預防丙泊酚注射痛的幾種方法評估. 河北醫學, 2010, 16(7): 847-849.
14.	Singh DK, Jindal P, Singh P. Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine. Saudi J Anaesth, 2011, 5(1): 50-54.
15.	Ambesh SP, Dubey PK, Sinha PK. Ondansetron Pretreatment to Alleviate Pain on Propofol Injection: A Randomized, Controlled, Double-Blinded Study. Anesth Analg, 1999, 89(1): 197-199.
16.	Ahmed A, Sengupta S, Das T. Pre-treatment randomized, control trial with intravenous granisetron to alleviate pain on propofol injection: a double-blind, randomized, controlled trial. Indian J Anaesh, 2010, 56(2): 135-138.
17.	Dubey PK, Prasad SS. Pain on Injection of Propofol: The Effect of Granisetron Pretreatment. Clin J Pain, 2003, 19(2): 121-124..
18.	Zahedi H, Maleki A, Rostami G. Gholamreza Rostami. Ondansetron Pretreatment reduces pain on injection of propofol. Acta Med Iran, 2012, 50(4): 239-243.
19.	Julian PT Higgins, Sally Green. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011. Available from: www.cochrane-handbook.org.
20.	Polat R, Aktay M, Ozlu O. The effects of remifentanil, lidocaine, metoclopramide, or ketamine pretreatment on propofol injection pain. Middle East J Anesthesiol. 2012, 21(5):673-7.
21.	閆諾, 楊程. 帕瑞昔布鈉防治丙泊酚注射痛的臨床觀察. 臨床麻醉學雜志, 2012, 28(1): 49-50.
22.	Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg, 1999, 88(5): 1085-1091.
23.	Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systemaitic review. Anesth Analg, 2000, 90(4): 963-969.
24.	Majedi H, Rabiee M, Khan ZH, et al. A comparion of metoclopramide and lidocaine for preventing pain on injection of diazepam. Anesth Analg, 2002, 95(5): 1297-1299.
25.	歐珊, 葉占勇, 胡玲. 異丙酚復合芬太尼或氯胺酮在無痛腸鏡中的對比觀察. 局解手術學雜志, 2003, 12(4): 273-274.
26.	Davies AF, Vaddodaria B, Hopwood B, et al. Efficacy of microfiltration in decreasing propofol induced pain. Anaesthesia, 2002, 57(6): 557-561.
27.	Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: acomparision of lidoeaine with alfentanil. Aneath Analg, 1996, 82(3): 469-471.
28.	Memis D, Turan A, Karamanlioglu B, et al. The prevention of pain from injection of rocuronium by ondansetron, idocaine, ramadol, and fentanyl. Anesth Analg, 2002, 94(6): 1517-1520.
29.	Ye JH, Mui WC, Ren J, et al. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg, 1997, 85(5): 1116-1121.
30.	Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, double blind controlled comparison with lidocaine. Anaesthesia, 2001, 56(9): 902-905.

1. Agarwal A, Ansari M, Gupta D, et al. Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection. Anesth Analg, 2004, 98 (3): 683-686.
2. Habib AS, Gsn TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth, 2004, 51(4): 326-341.
3. Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth, 2001, 47(10): 1008-1018.
4. 劉啟敏, 周建敏, 鄒筱萌, 等. 昂丹司瓊聯合小劑量舒芬太尼預防異丙酚注射痛的臨床觀察. 海峽藥學, 2011, 23(4): 114-115.
5. 朱明. 昂丹司瓊與利多卡因預防異丙酚注射痛的對照研究. 山西醫藥雜志, 2012, 41(3): 263-265.
6. 嚴映霞, 牟鎮, 伍智慧. 低溫﹑昂丹司瓊﹑利多卡因單用和合用對丙泊酚注射痛的防治比較.中國社區醫師·醫學專業, 2011, 13(32): 175-176.
7. 陸宏. 靜脈注射昂丹司瓊對丙泊酚注射痛的預防作用. 牡丹江醫學院學報, 2011, 32(5): 39-40.
8. 曹東航, 丁進峰, 王明倉, 等. 利多卡因和恩丹西酮減輕異丙酚注射痛的效果比較. 現代醫藥衛生, 2005, 21(19): 2578-2579.
9. 馬玉姍, 林雪梅, 周俊. 格拉司瓊復合利多卡因減輕異丙酚注射痛的隨機雙盲對照研究. 四川大學學報(醫學版), 2009, 40(3): 536-538.
10. 傅海青. 格拉司瓊復合利多卡因靜脈預處理減輕異丙酚所致注射痛和嘔吐的臨床觀察. 中國藥房, 2010, 21(16): 1476-1478.
11. 劉楓, 葛衡江, 周蓉. 托烷司瓊對丙泊酚靜脈注射痛的預防作用. 中國醫院藥學雜志, 2006, 26(2): 192-193.
12. 邵麗麗, 呂黃偉, 田阿勇. 托烷司瓊復合利多卡因預防丙泊酚注射痛的療效觀察. 中國血液流變學雜志, 2011, 21(2): 284-286.
13. 涂昕祥. 預防丙泊酚注射痛的幾種方法評估. 河北醫學, 2010, 16(7): 847-849.
14. Singh DK, Jindal P, Singh P. Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine. Saudi J Anaesth, 2011, 5(1): 50-54.
15. Ambesh SP, Dubey PK, Sinha PK. Ondansetron Pretreatment to Alleviate Pain on Propofol Injection: A Randomized, Controlled, Double-Blinded Study. Anesth Analg, 1999, 89(1): 197-199.
16. Ahmed A, Sengupta S, Das T. Pre-treatment randomized, control trial with intravenous granisetron to alleviate pain on propofol injection: a double-blind, randomized, controlled trial. Indian J Anaesh, 2010, 56(2): 135-138.
17. Dubey PK, Prasad SS. Pain on Injection of Propofol: The Effect of Granisetron Pretreatment. Clin J Pain, 2003, 19(2): 121-124..
18. Zahedi H, Maleki A, Rostami G. Gholamreza Rostami. Ondansetron Pretreatment reduces pain on injection of propofol. Acta Med Iran, 2012, 50(4): 239-243.
19. Julian PT Higgins, Sally Green. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011. Available from: www.cochrane-handbook.org.
20. Polat R, Aktay M, Ozlu O. The effects of remifentanil, lidocaine, metoclopramide, or ketamine pretreatment on propofol injection pain. Middle East J Anesthesiol. 2012, 21(5):673-7.
21. 閆諾, 楊程. 帕瑞昔布鈉防治丙泊酚注射痛的臨床觀察. 臨床麻醉學雜志, 2012, 28(1): 49-50.
22. Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg, 1999, 88(5): 1085-1091.
23. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systemaitic review. Anesth Analg, 2000, 90(4): 963-969.
24. Majedi H, Rabiee M, Khan ZH, et al. A comparion of metoclopramide and lidocaine for preventing pain on injection of diazepam. Anesth Analg, 2002, 95(5): 1297-1299.
25. 歐珊, 葉占勇, 胡玲. 異丙酚復合芬太尼或氯胺酮在無痛腸鏡中的對比觀察. 局解手術學雜志, 2003, 12(4): 273-274.
26. Davies AF, Vaddodaria B, Hopwood B, et al. Efficacy of microfiltration in decreasing propofol induced pain. Anaesthesia, 2002, 57(6): 557-561.
27. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: acomparision of lidoeaine with alfentanil. Aneath Analg, 1996, 82(3): 469-471.
28. Memis D, Turan A, Karamanlioglu B, et al. The prevention of pain from injection of rocuronium by ondansetron, idocaine, ramadol, and fentanyl. Anesth Analg, 2002, 94(6): 1517-1520.
29. Ye JH, Mui WC, Ren J, et al. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg, 1997, 85(5): 1116-1121.
30. Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, double blind controlled comparison with lidocaine. Anaesthesia, 2001, 56(9): 902-905.

《中國循證醫學雜志》

5-羥色胺受體拮抗劑預防丙泊酚注射痛有效性和安全性的Meta分析

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《中國循證醫學雜志》

5-羥色胺受體拮抗劑預防丙泊酚注射痛有效性和安全性的Meta分析

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