P6刺激对术后恶心呕吐有效性的Meta分析_《中国循证医学杂志》

作者：

朱丹 ,  吕黄伟

中国医科大学附属第一医院麻醉科（沈阳 110001）;

关键词：

P6刺激针刺术后恶心呕吐 Meta分析

DOI：

10.7507/1672-2531.20100521

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

目的采用Meta分析比较P6（内关穴：NeiGuan）刺激与假刺激/安慰剂/药物预防术后恶心呕吐（POVN）的有效性。
方法计算机检索PubMed（1990～2010）、OVID全文数据库（1990～2010）、EBSCO（1990～2010）、Cochrane 图书馆（1996～2010）、中国学术期刊网全文数据库（CNKI，1999～2010），美国科学院院刊（PNAS1990～2010）和High Wire Pres数据库（1990～2010），手工检索《中华麻醉学杂志》（1990/2010）、Anastasia等5种中外文期刊。按照纳入与排除标准进行文献筛选和质量评价后，采用随机效应模型进行Meta分析。
结果最终纳入21篇文献，其中2篇为多中心随机双盲对照研究，4篇为随机单盲对照研究，其余15篇均为单中心随机双盲对照研究（Ⅱa级）。Meta分析结果显示：① 与假刺激相比，P6刺激可有效预防术后恶心（开始～研究终止）（P lt;0.000 01）、术后早期恶心（ lt;术后6 h）（P=0.000 6）和术后后期恶心（ gt;术后6 h）（P=0.001）。② 与假刺激相比，P6刺激也可有效预防术后呕吐（开始～研究终止）（P lt;0.000 1）、术后早期呕吐（ lt;术后6 h）（P=0.002），但对术后后期呕吐（ gt;术后6 h）无预防作用（P=0.08）。③ 与药物干预相比，P6刺激预防术后恶心（P=0.29）、呕吐（P=0.15）的有效性较弱。
结论 P6刺激相对于假刺激可有效预防术后早期恶心呕吐（术后0～6 h）、后期恶心，但对术后后期呕吐（术后6～12 h）并无预防作用。相对于药物而言，尚需高质量临床试验来证明P6刺激可以取代药物预防术后恶心呕吐发生。

引用本文： 朱丹,吕黄伟. P6刺激对术后恶心呕吐有效性的Meta分析. 中国循证医学杂志, 2010, 10(8): 928-931. doi: 10.7507/1672-2531.20100521 复制

1.	Dundee JW, McMillan CM. Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res, 1990, 15(3-4): 211-215.
2.	Boehler M, Mitterschiffthaler G, Schlager A, et al. Korean Hand Acupressure Reduces Postoperative Nausea and Vomiting After Gynecological Laparoscopic Surgery. Anesth Analg, 2002, 94(4): 872–875.
3.	Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure Versus Intravenous Metoclopramide to Prevent Nausea and Vomiting During Spinal Anesthesia for Cesarean Section. Anesth Analg, 1997, 84(2): 342-345.
4.	Gan TJ, Jiao KR, Zenn M, et al. A Randomized Controlled Comparison of Electro-Acupoint Stimulation or Ondansetron Versus Placebo for the Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 2004, 99(4): 1070-1075.
5.	Habib AS, Itchon-Ramoset N, Phillips-Bute BG, et al. Transcutaneous Acupoint Electrical Stimulation with the ReliefBand® for the Prevention of Nausea and Vomiting During and After Cesarean Delivery Under Spinal Anesthesia. Anesth Analg, 2006, 102(2): 581-584.
6.	Harmon D, Ryan M, Kelly A, et al. Acupressure and prevention of nausea and vomiting during and after spinal anaeathesia for caesarean section. Br J Anaesth, 2000, 84(4): 463-467.
7.	Frey UH, Funk M, Lohlein C, et al. FUNK Effect of P6 acustimulation on post-operative nausea and vomiting in patients undergoing a laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2009, 53(10): 1341-1347.
8.	Arnberger M, Stadelmann K, Alischer P, et al. Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting. Anesthesiology, 2007, 107(6): 903-908.
9.	Sadighha A, Nurai N. Acupressure wristbands versus metoclopramide for the prevention of postoperative nausea and vomiting. Ann Saudi Med, 2008, 28(4): 287-291.
10.	Klein AA, Djaiani G, Karski J, et al. Acupressure Wristbands for the Prevention of Postoperative Nausea and Vomiting in Adults Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth, 2004, 18(1): 68-71.
11.	Schultz AA, Andrews AL, Goran SG, et al. Comparison of Acupressure Bands and Droperidol for Reducing Post-operative Nausea and Vomiting in Gynecologic Surgery Patients. Applied Nursing Research, 2003, 16(4): 256-265.
12.	Harmon D, Gardiner J, Harrison R, et al. Acupressure and the prevention nausea and vomiting after laparoscopy. Br J Anaesth, 1999, 82(3): 387-390.
13.	Fan FC, Tanhui E, Joshi S, et al. Acupressure Treatment for Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 1997, 84(4): 821-825.
14.	Ferrara-Love R,Sekeres L, Bircher NG, et al. Nonpharmacologic Treatment of Postoperative Nause. J PeriAnesthesia Nursing, 1996, 11(6): 378-383.
15.	Wang XQ, Yu JL, Du ZY, et al. Electroacupoint Stimulation for Postoperative Nausea and Vomiting in Patients Undergoing Supratentorial Craniotomy. J Neurosurg Anesthesiol, 2010, 22(2): 128-131.
16.	Duggal KN, Douglas MJ, Peter EA, et al. Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. Int Obstet Anesth, 1998, 7(4): 231-236.
17.	Alkaissi A, Evertsson K, Johnsson Vivi-Ann, et al. P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women. Can J Anesth, 2002, 49(10): 1034-1039.
18.	Zárate E, Mingus M, White PF, et al. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg, 2001, 92(3): 629-635.
19.	Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in chindren undergoing strabismus surgery. Br J Anaesth, 1998, 81(4): 529-532.
20.	Alkaissi A, Stalnert M, Kalman S. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery. Acta Anaesthesioloqica Scandinavica, 1999, 43(3): 270-274.
21.	Turgut S, Ozalp G, Dikmen S, et al. Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient-controlled analgesia. Eur J Anaesthesiol, 2007, 24(1): 87-91.
22.	Coloma M, White PF, Ogunnaike BO, et al. Comparison of Acustimulation and Ondansetron for the Treatment of Established Postoperative Nausea and Vomiting. Anesthesiology, 2002, 97(6): 1387-1392.
23.	White PF, Issioui T, Hu J. Comparative Efficacy of Acustimulation (ReliefBand®) versus Ondansetron (Zofran®) in Combination with Droperidol for Preventing Nausea and Vomiting. Anesthesiology, 2002, 97(5): 1075-1081.
24.	Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesthesia and analgesia, 1997, 84(2): 342-345.
25.	Tang J, Chen X, White PF, et al. Antiemetic prophylaxis for office-based surgery: are the 5-HT3 receptor antagonists beneficial. Anesthesiology, 2003, 98(2): 293-298.

1. Dundee JW, McMillan CM. Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res, 1990, 15(3-4): 211-215.
2. Boehler M, Mitterschiffthaler G, Schlager A, et al. Korean Hand Acupressure Reduces Postoperative Nausea and Vomiting After Gynecological Laparoscopic Surgery. Anesth Analg, 2002, 94(4): 872–875.
3. Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure Versus Intravenous Metoclopramide to Prevent Nausea and Vomiting During Spinal Anesthesia for Cesarean Section. Anesth Analg, 1997, 84(2): 342-345.
4. Gan TJ, Jiao KR, Zenn M, et al. A Randomized Controlled Comparison of Electro-Acupoint Stimulation or Ondansetron Versus Placebo for the Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 2004, 99(4): 1070-1075.
5. Habib AS, Itchon-Ramoset N, Phillips-Bute BG, et al. Transcutaneous Acupoint Electrical Stimulation with the ReliefBand® for the Prevention of Nausea and Vomiting During and After Cesarean Delivery Under Spinal Anesthesia. Anesth Analg, 2006, 102(2): 581-584.
6. Harmon D, Ryan M, Kelly A, et al. Acupressure and prevention of nausea and vomiting during and after spinal anaeathesia for caesarean section. Br J Anaesth, 2000, 84(4): 463-467.
7. Frey UH, Funk M, Lohlein C, et al. FUNK Effect of P6 acustimulation on post-operative nausea and vomiting in patients undergoing a laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2009, 53(10): 1341-1347.
8. Arnberger M, Stadelmann K, Alischer P, et al. Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting. Anesthesiology, 2007, 107(6): 903-908.
9. Sadighha A, Nurai N. Acupressure wristbands versus metoclopramide for the prevention of postoperative nausea and vomiting. Ann Saudi Med, 2008, 28(4): 287-291.
10. Klein AA, Djaiani G, Karski J, et al. Acupressure Wristbands for the Prevention of Postoperative Nausea and Vomiting in Adults Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth, 2004, 18(1): 68-71.
11. Schultz AA, Andrews AL, Goran SG, et al. Comparison of Acupressure Bands and Droperidol for Reducing Post-operative Nausea and Vomiting in Gynecologic Surgery Patients. Applied Nursing Research, 2003, 16(4): 256-265.
12. Harmon D, Gardiner J, Harrison R, et al. Acupressure and the prevention nausea and vomiting after laparoscopy. Br J Anaesth, 1999, 82(3): 387-390.
13. Fan FC, Tanhui E, Joshi S, et al. Acupressure Treatment for Prevention of Postoperative Nausea and Vomiting. Anesth Analg, 1997, 84(4): 821-825.
14. Ferrara-Love R,Sekeres L, Bircher NG, et al. Nonpharmacologic Treatment of Postoperative Nause. J PeriAnesthesia Nursing, 1996, 11(6): 378-383.
15. Wang XQ, Yu JL, Du ZY, et al. Electroacupoint Stimulation for Postoperative Nausea and Vomiting in Patients Undergoing Supratentorial Craniotomy. J Neurosurg Anesthesiol, 2010, 22(2): 128-131.
16. Duggal KN, Douglas MJ, Peter EA, et al. Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. Int Obstet Anesth, 1998, 7(4): 231-236.
17. Alkaissi A, Evertsson K, Johnsson Vivi-Ann, et al. P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women. Can J Anesth, 2002, 49(10): 1034-1039.
18. Zárate E, Mingus M, White PF, et al. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg, 2001, 92(3): 629-635.
19. Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in chindren undergoing strabismus surgery. Br J Anaesth, 1998, 81(4): 529-532.
20. Alkaissi A, Stalnert M, Kalman S. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery. Acta Anaesthesioloqica Scandinavica, 1999, 43(3): 270-274.
21. Turgut S, Ozalp G, Dikmen S, et al. Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient-controlled analgesia. Eur J Anaesthesiol, 2007, 24(1): 87-91.
22. Coloma M, White PF, Ogunnaike BO, et al. Comparison of Acustimulation and Ondansetron for the Treatment of Established Postoperative Nausea and Vomiting. Anesthesiology, 2002, 97(6): 1387-1392.
23. White PF, Issioui T, Hu J. Comparative Efficacy of Acustimulation (ReliefBand®) versus Ondansetron (Zofran®) in Combination with Droperidol for Preventing Nausea and Vomiting. Anesthesiology, 2002, 97(5): 1075-1081.
24. Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesthesia and analgesia, 1997, 84(2): 342-345.
25. Tang J, Chen X, White PF, et al. Antiemetic prophylaxis for office-based surgery: are the 5-HT3 receptor antagonists beneficial. Anesthesiology, 2003, 98(2): 293-298.

《中国循证医学杂志》

P6刺激对术后恶心呕吐有效性的Meta分析

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《中国循证医学杂志》

P6刺激对术后恶心呕吐有效性的Meta分析

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