与阿片类药物相关的手术后恶心和吐在经过 laparoscopic 子宫切除术的妇女:一个网络的元分析
Sueyoung Cho1, Heesoo Bang1, Sangyoon Shin1
1Research Institute of Pharmaceutical Sciences, Natural Products Research Institute, College of Pharmacy, Seoul National University, Seoul 08826, Republic of Korea.
Medicina (Kaunas, Lithuania)
|October 29, 2025
概括
这次审查发现,在各种阿片类单一治疗中,术后恶心和吐 (PONV) 风险没有显著差异. 然而,像德克斯梅托米丁/凯托洛拉克这样的阿片类药物节约疗法,与氧化组合相比,降低了PONV风险.
科学领域:
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
- 妇科外科手术 妇科外科
背景情况:
- 手术后恶心和吐 (PONV) 是腹腔镜切除子宫术后的一个常见并发症.
- 类阿片类止痛药经常用于治疗疼痛,但可以加剧PONV.
- 评估不同阿片类药物治疗方案的比较风险对于优化患者护理至关重要.
研究的目的:
- 系统地审查和进行网络元分析,研究手术后阿片类药物使用对经腹腔镜切除子宫的女性PONV的影响.
- 为了比较不同止痛干预措施中与阿片类药物相关的术后恶心和吐 (O-PONV) 的风险.
- 确定最佳的止痛策略,以最大限度地降低O-PONV风险.
主要方法:
- 在主要数据库 (PubMed,EMBASE,Cochrane Library,RISS) 系统搜索相关的随机对照试验.
- 使用柯克兰偏差风险2工具对包含的研究进行质量评估.
- 频率网络的元分析,以比较O-PONV风险,通过P-score在森林地块和处理排名中展示的结果.
主要成果:
- 分析了17项涉及1315名参与者的研究和18项干预措施.
- 在六种阿片类药物单一治疗 (布普伦诺芬,布托尔巴诺,芬太尼,氧科,苏芬坦尼尔,塔达尔) 中,在O-PONV风险上没有发现显著差异.
- 与其他基托洛拉克疗法 (例如,德克斯梅托米丁/基托洛拉克) 相比,氧化/基托洛拉克的联合治疗显示出明显更高的O-PONV风险.
结论:
- 阿片类药物单一疗法在引起O-PONV的风险上没有显著差异.
- 与基于氧化的疗法相比,阿片类药物节约性止痛策略,如德克斯梅托米丁/凯托洛拉克,与O-PONV风险较低有关.
- 术后疼痛管理应考虑以患者为中心的因素,如偏好和给药途径,以尽量减少O-PONV.
相关概念视频
Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
665
Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
Two synthetic agonists of THC,...
665
Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
564
Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy. SP binds and activates...
564
Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
594
5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
594
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
548
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
548
Opioid Analgesics: Morphine and Other Natural Cogeners
841
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
841
Drugs Affecting GI Tract Motility: Opioids as Antidiarrheal Agents
607
Diarrhea, a condition marked by frequent loose or watery bowel movements, can be triggered by multiple factors such as viral or bacterial infections, food intolerances, anxiety, medications, and digestive disorders. Symptoms may include abdominal pain, bloating, nausea, and cramping. Severe or prolonged diarrhea can lead to complications like electrolyte imbalances, malnutrition, and dehydration if left untreated.
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
607


