5-羟色胺受体拮抗剂预防丙泊酚注射痛有效性和安全性的Meta分析_《中国循证医学杂志》

作者：

李淑英 ,  王晓

四川大学华西医院麻醉科（成都 610041）;

关键词：

5-羟色胺受体拮抗剂丙泊酚注射痛系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130078

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5-羟色胺（5-HT3）受体拮抗剂预防丙泊酚注射痛的有效性和安全性。
方法　计算机检索PubMed、EMbase、The Cochrane Library（2012年第1期）、CNKI、CBM、VIP和WanFang Data，查找有关5-HT3受体拮抗剂预防丙泊酚注射痛的随机对照试验（RCT），检索时限均从建库至2012年9月。由2位研究人员按照纳入和排除标准独立筛选文献、提取资料和评价质量后，然后采用RevMan 5.2软件进行Meta分析。
结果　最终纳入15个RCT，共1 413例患者。Meta分析结果显示：① 5-HT3组丙泊酚注射痛发生率明显小于对照组［RR=0.14，95%CI（0.09，0.21），P lt;0.000 01］；② 在疼痛程度方面，两组轻度注射痛差异无统计学意义［RR=0.84，95%CI（0.56，1.26），P=0.39］；5-HT3组丙泊酚中度注射痛［RR=0.25，95%CI（0.19，0.34），P lt;0.000 01］和重度注射痛的发生率［RR=0.16，95%CI（0.10，0.24），P lt;0.000 01］均明显低于对照组。③ 在术后不良反应方面，5-HT3组术后恶心和呕吐［RR=0.19，95%CI（0.11，0.34），P lt;0.000 01］及寒颤［RR=0.20，95%CI（0.12，0.33），P lt;0.000 01］的发生率均明显少于对照组。
结论　5-HT3受体拮抗剂能有效预防丙泊酚注射痛，且能减轻丙泊酚注射的疼痛程度和术后不良反应发生率。受纳入研究的数量和质量限制，上述结论尚待开展更多高质量研究加以验证。

引用本文： 李淑英,王晓. 5-羟色胺受体拮抗剂预防丙泊酚注射痛有效性和安全性的Meta分析. 中国循证医学杂志, 2013, 13(4): 452-460. doi: 10.7507/1672-2531.20130078 复制

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.	刘启敏, 周建敏, 邹筱萌, 等. 昂丹司琼联合小剂量舒芬太尼预防异丙酚注射痛的临床观察. 海峡药学, 2011, 23(4): 114-115.
5.	朱明. 昂丹司琼与利多卡因预防异丙酚注射痛的对照研究. 山西医药杂志, 2012, 41(3): 263-265.
6.	严映霞, 牟镇, 伍智慧. 低温﹑昂丹司琼﹑利多卡因单用和合用对丙泊酚注射痛的防治比较.中国社区医师·医学专业, 2011, 13(32): 175-176.
7.	陆宏. 静脉注射昂丹司琼对丙泊酚注射痛的预防作用. 牡丹江医学院学报, 2011, 32(5): 39-40.
8.	曹东航, 丁进峰, 王明仓, 等. 利多卡因和恩丹西酮减轻异丙酚注射痛的效果比较. 现代医药卫生, 2005, 21(19): 2578-2579.
9.	马玉姗, 林雪梅, 周俊. 格拉司琼复合利多卡因减轻异丙酚注射痛的随机双盲对照研究. 四川大学学报(医学版), 2009, 40(3): 536-538.
10.	傅海青. 格拉司琼复合利多卡因静脉预处理减轻异丙酚所致注射痛和呕吐的临床观察. 中国药房, 2010, 21(16): 1476-1478.
11.	刘枫, 葛衡江, 周蓉. 托烷司琼对丙泊酚静脉注射痛的预防作用. 中国医院药学杂志, 2006, 26(2): 192-193.
12.	邵丽丽, 吕黄伟, 田阿勇. 托烷司琼复合利多卡因预防丙泊酚注射痛的疗效观察. 中国血液流变学杂志, 2011, 21(2): 284-286.
13.	涂昕祥. 预防丙泊酚注射痛的几种方法评估. 河北医学, 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.	闫诺, 杨程. 帕瑞昔布钠防治丙泊酚注射痛的临床观察. 临床麻醉学杂志, 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.	欧珊, 叶占勇, 胡玲. 异丙酚复合芬太尼或氯胺酮在无痛肠镜中的对比观察. 局解手术学杂志, 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. 刘启敏, 周建敏, 邹筱萌, 等. 昂丹司琼联合小剂量舒芬太尼预防异丙酚注射痛的临床观察. 海峡药学, 2011, 23(4): 114-115.
5. 朱明. 昂丹司琼与利多卡因预防异丙酚注射痛的对照研究. 山西医药杂志, 2012, 41(3): 263-265.
6. 严映霞, 牟镇, 伍智慧. 低温﹑昂丹司琼﹑利多卡因单用和合用对丙泊酚注射痛的防治比较.中国社区医师·医学专业, 2011, 13(32): 175-176.
7. 陆宏. 静脉注射昂丹司琼对丙泊酚注射痛的预防作用. 牡丹江医学院学报, 2011, 32(5): 39-40.
8. 曹东航, 丁进峰, 王明仓, 等. 利多卡因和恩丹西酮减轻异丙酚注射痛的效果比较. 现代医药卫生, 2005, 21(19): 2578-2579.
9. 马玉姗, 林雪梅, 周俊. 格拉司琼复合利多卡因减轻异丙酚注射痛的随机双盲对照研究. 四川大学学报(医学版), 2009, 40(3): 536-538.
10. 傅海青. 格拉司琼复合利多卡因静脉预处理减轻异丙酚所致注射痛和呕吐的临床观察. 中国药房, 2010, 21(16): 1476-1478.
11. 刘枫, 葛衡江, 周蓉. 托烷司琼对丙泊酚静脉注射痛的预防作用. 中国医院药学杂志, 2006, 26(2): 192-193.
12. 邵丽丽, 吕黄伟, 田阿勇. 托烷司琼复合利多卡因预防丙泊酚注射痛的疗效观察. 中国血液流变学杂志, 2011, 21(2): 284-286.
13. 涂昕祥. 预防丙泊酚注射痛的几种方法评估. 河北医学, 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. 闫诺, 杨程. 帕瑞昔布钠防治丙泊酚注射痛的临床观察. 临床麻醉学杂志, 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. 欧珊, 叶占勇, 胡玲. 异丙酚复合芬太尼或氯胺酮在无痛肠镜中的对比观察. 局解手术学杂志, 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.

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5-羟色胺受体拮抗剂预防丙泊酚注射痛有效性和安全性的Meta分析

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《中国循证医学杂志》

5-羟色胺受体拮抗剂预防丙泊酚注射痛有效性和安全性的Meta分析

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