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摘要：
目的 系统评价昂丹司琼预防妇科腹腔镜全麻术后恶心呕吐的有效性和安全性。方法 电子检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、重庆维普中文科技期刊全文数据库、万方数据库，Pubmed，Springer，Embase，Web of knowledge数据库，并查阅所获文献的参考文献，收集1995~2012年发表的有关昂丹斯琼预防妇科腹腔镜全麻术后恶心呕吐的随机对照试验(RCT)。按Cochrane Handbook 5.0.1对纳入文献进行质量评价和资料提取，统计学分析采用stata11.0软件。结果 共纳入18个RCT，包括1597例患者。Meta分析结果显示：(1)有效性：昂丹司琼单次静脉注射能降低妇科腹镜全麻术后恶心呕吐的发生率[（RR=0.210,95%CI=0.164~0.268）]；昂丹司琼4mg与8mg单次静脉注射对预防妇科腹腔镜全麻术后患者24hPONV效果相当[（RR=0.948,95%CI=0.433~2.075）]；手术前期应用昂丹司琼较术毕应用患者PONV发生率更低[（RR=0.450,95%CI=0.290~0.698）]；昂丹斯琼4mg或氟哌利多静脉注射患者术后24hPONV发生率相同[（RR=1.36,95%CI=0.74~2.51）]；昂丹司琼联合氟哌利多静脉注射预防术后PONV发生较单独使用昂丹司琼效果更好[（RR=3.56,95%CI=1.74~7.29）]。(2)安全性：昂丹司琼静脉注射不增加头痛、低热的发生率。结论 昂丹司琼4mg术前静脉注射能明显降低妇科腹腔镜全麻术后恶心呕吐的发生率，且不会增加头痛、低热等不良反应的发生率。昂丹司琼联合小剂量氟哌利多静脉注射较单独使用昂丹司琼对预防妇科腹腔镜全麻术后恶心呕吐的发生效果更好。
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Abstract: Objective To evaluate the efficacy and safety of 5-HT3 receptor inhibitor ondansetron injected in the postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia. Methods We searched the CNKI, CBM, Chongqing VIP, Wanfang Data Base, Pubmed, Springer, Embase, and Web of knowledge to identify randomized controlled trials (RCTs) about ondansetron in preventing PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia from 1995 to 2012.We also consulted references of the included studies for omission.The methodological quality of the included RCTs was assessed and data were extracted according to the standard of the Cochrane Handbook5.0.1.The meta-analyses were performed by stata11.0 software. A total of 18 RCTs involving 1597 patients were included. Results The results of meta-analyses showed that:(1)Efficacy:ondansetron injected could decrease the incidence of PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia(RR=0.210,95%CI=0.164~0.268),and a single 8mg IV dose of ondansetron is no more effective than a single 4mg IV dose of ondansetron for prevention (RR=0.948, 95%CI=0.433~2.075),furthermore,ondanstron administered at the beginning of the gynecological laparoscopic procedures is more effective in preventing PONV than at the end of the surgery (RR=0.450,95%CI=0.290~0.698).Moreover,equivalent efficacy was seen between the ondansetron and droperidol in reducing PONV in patients undergoing gynecological laparoscopic survey,but the combination of ondansetron and droperidol further attenuated this incidence when compared to 4 mg ondansetron alone.(2)Safety:ondansetron injected could not significantly lessen the incidence of postoperative headache and fever. Conclusions A single 4mg IV dose of ondansetron injected at the beginning of the gynecological laparoscopic survey can significantly decrease the incidence of PONV after general anesthesia, and it will not increase the adverse effect and the incidence of postoperative complications.And the combination of ondansetron and low dose of droperidol is more efficacious as a prophylactic anti-emetic than ondansetron alone in women undergoing general anesthesia for gynecological laparoscopy.
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