围手术期葡萄糖输注与术后恶心呕吐：随机试验的meta分析
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Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials
背景与目的
研究表明围手术期静脉注射葡萄糖可降低术后恶心和呕吐的发生风险，在此项meta分析中，作者旨在探讨术中或术后输注葡萄糖对术后恶心和呕吐的影响。
方 法
本试验检索了PubMed、Embase、Cochrane图书馆和Google学术网站研究了围手术期静脉输注葡萄糖预防术后恶心和呕吐的相关随机对照试验；主要结果是术后恶心和呕吐的发生率（PACCU和术后24小时内），次要结果包括术后止吐给药和血糖水平。
结 果
本研究共纳入10项随机对照试验（n=987名患者），其中围手术期葡萄糖输注患者465名，对照组患者522名；围手术期葡萄糖输注与术后恶心和呕吐的显著减少无关：PACU（RR=0.91，95%CI=0.73-1.15；P=0.44）、术后24小时内（RR=0.76，95%CI=0.55-1.04；P=0.09），但围术期输注葡萄糖与术后24小时内抗呕吐药的使用显著减少有关（RR=0.55，95%CI，0.45-0.69；P<0.001），同时与对照组比较，围术期葡糖输注组患者术后血糖水平增加。
结 论
本研究发现围手术期使用葡萄糖与术后恶心呕吐无统计学意义上的相关性。当葡糖糖输注或使用时，建议进行血糖监测。
原始文献摘要
Zorrilla-Vaca A, Marmolejo-Posso D, Stone A, Li J, Grant MC. Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials. Anesth Analg. 2019 Jan 14. doi: 10.1213/ANE. 0000000000004019. [Epub ahead of print] PubMed PMID: 30649067.
BACKGROUND:Perioperative IV dextrose infusions have been investigated for their potential to reduce the risk of posto-perative nausea and vomiting. In this meta- analysis, we inves-tigated the use of an intraoperative or
postoperative infusion of dextrose for the prevention of postoperative nausea and vomiting.
METHODS:Our group searched PubMed, Embase, Cochrane library, and Google Scholar for relevant randomized controlled trials examining the use of perioperative IV dextrose for prevention of postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting (both in the postanesthesia care unit and within the first 24 h of surgery). Secondary outcomes included postoperative antiemetic administration and serum glucose level.
RESULTS:Our search yielded a total of 10 randomized controlled trials (n = 987 patients) comparing the use of a perioperative dextrose infusion (n = 465) to control (n = 522). Perioperative dextrose infusion was not associated with a significant reduction in postoperative nausea and vomiting in the postanesthesia care unit (risk ratio = 0.91, 95% CI, 0.73-1.15; P = 0.44) or within the first 24 h (risk ratio = 0.76, 95% CI, 0.55-1.04; P =0 .09) of surgery. Although the use of dextrose was associated with a significant reduction in antiemetic administration within the first 24 h (risk ratio = 0.55, 95% CI, 0.45-0.69; P < 0.001), it also increased postoperative plasma glucose levels compared to controls.
CONCLUSIONS:The use of perioperative dextrose did not result in a statistically significant association with postoperative nausea and vomiting. When utilized, plasma glucose monitoring is recommended to assess for postoperative hyperglycemia. Further prospective trials are necessary to examine the potential impact of timing of administration of a dextrose infusion on incidence of postoperative nausea and vomiting and rescue antiemetic requirements.
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贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：余晓旭 审校：王贵龙