Efficacy of Palonosetron vs. Ramosetron for the Prevention of Postoperative Nausea and Vomiting: A Meta-Analysis of Randomized Controlled Trials.
Efficacy of Palonosetron vs. Ramosetron for the Prevention of Postoperative Nausea and Vomiting: A Meta-Analysis of Randomized Controlled Trials.
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DOI：
10.3349/ymj.2017.58.4.848
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发表时间：
2017-07
影响因子：
2.4
通讯作者：
Shin S
中科院分区：
文献类型：
--
作者：
Kim MS;Park JH;Choi YS;Park SH;Shin S
本研究是随机对照试验(RCT)的荟萃分析，其中包括帕洛诺司琼和雷莫司琼预防术后恶心呕吐(PONV)的比较。系统检索PubMed、EMBASE、Web of Science、Central、Korea Med和Google Scholar数据库(PROSPERO协议号CRD42015026009)。主要结果是术后48小时内恶心(PON)和呕吐(POV)的发生率。在0-6小时(早期)、6-24小时(晚期)和24-48小时(延迟)的时间周期中进一步分析了总的48小时周期。根据危险因素的数量、性别和手术类型进行亚组分析。分析了包括第1373名患者在内的11项研究。术后48小时内，两种药物的PON或POV均无差异。然而，帕洛诺司琼在延迟期的总体预防POV方面更为有效[相对危险度(RR)0.59；95%可信区间(CI)0.39至0.89；p=0.013]，以及对女性和腹腔镜组进行分组分析(RR，0.56；95%CI，0.36至0.86；p=0.009和RR，0.46；95%CI，0.23至0.94；p=0.033)。脊柱手术的亚组分析显示，雷莫司琼在总48小时内(RR，3.34；95%CI，1.46~7.63；p=0.004)和早期(RR，8.47；95%CI，1.57~45.72；p=0.013)在降低POV方面效果更好。这一荟萃分析发现，两种药物在预防PONV方面没有明确的差异。在不同时期和亚组分析中看到的重要发现应该在未来的随机对照试验中得到证实。
This study was designed as a meta-analysis of randomized controlled trials (RCTs) that included the comparison of palonosetron and ramosetron for postoperative nausea and vomiting (PONV) prophylaxis. A systematic search was conducted for the PubMed, EMBASE, Web of Science, CENTRAL, KoreaMed, and Google Scholar databases (PROSPERO protocol number CRD42015026009). Primary outcomes were the incidences of postoperative nausea (PON) and postoperative vomiting (POV) during the first 48 hrs after surgery. The total 48-hr period was further analyzed in time epochs of 0–6 hrs (early), 6–24 hrs (late), and 24–48 hrs (delayed). Subgroup analyses according to number of risk factors, sex, and type of surgery were also performed. Eleven studies including 1373 patients were analyzed. There was no difference in PON or POV between the two drugs for the total 48-hr period after surgery. However, palonosetron was more effective in preventing POV during the delayed period overall [relative risk (RR), 0.59; 95% confidence interval (CI), 0.39 to 0.89; p=0.013], as well as after subgroup analyses for females and laparoscopies (RR, 0.56; 95% CI, 0.36 to 0.86; p=0.009 and RR, 0.46; 95% CI, 0.23 to 0.94; p=0.033). Subgroup analysis for spine surgery showed that ramosetron was more effective in reducing POV during the total 48-hr (RR, 3.34; 95% CI, 1.46 to 7.63; p=0.004) and early periods (RR, 8.47; 95% CI, 1.57 to 45.72; p=0.013). This meta-analysis discovered no definite difference in PONV prevention between the two drugs. The significant findings that were seen in different time epochs and subgroup analyses should be confirmed in future RCTs.