Pang Liwei, Cui Meiying, Dai Wanling, Kong Jing, Chen Hongzhi, Wu Shuodong
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang, China.
Front Pharmacol. 2020 Oct 19;11:586104. doi: 10.3389/fphar.2020.586104. eCollection 2020.
Postoperative depression is a common complication after surgery that profoundly affects recovery and prognosis. New research indicates that (,)-ketamine is a potent antidepressant that exerts a rapid and sustained antidepressive effect. However, there is no consensus on whether intraoperative low-dose (,)-ketamine prevents postoperative depression. This study aimed to investigate the safety, feasibility, and short-term complications of intraoperative low-dose (,)-ketamine in preventing postoperative depressive symptoms. The Web of Science, Cochrane, PubMed, and CNKI databases were systematically searched (last search February 28, 2020) to identify studies involving ketamine. Sensitivity and metaregression analyses were performed to identify potential confounders. The meta-analysis was performed using Review Manager 5.3. A total of 13 studies (seven in Chinese and six in English) representing 1,148 cases of patients who were treated with (,)-ketamine and 874 cases of patients who received other treatments were included in the meta-analysis. Anesthesia duration and blood loss did not significantly differ between the two groups, demonstrating that (,)-ketamine was safe (odds ratio,OR: 0.27; 95% CI: -1.14 to 1.68; P = 0.71) for prophylactic treatment of postoperative depression. Blood loss (OR: -1.83; 95% CI: -8.34 to 4.68; P = 0.58), the number of postoperative depressive patients (95% CI: 0.8-1.07; P = 0.08; (,)-ketamine: control = 12.9%:15.8%), and postoperative complications (OR: 0.83, 95% CI: 0.44-1.58; P = 0.57; (,)-ketamine: control = 19.3%:19.3%) were all similar across groups. Intra-operative low-dose (,)-ketamine reduced extubation time (OR: -2.84; 95% CI: -5.48 to -0.21; P = 0.03). The prophylactic anti-depressant effect of (,)-ketamine did not significantly differ between the (,)-ketamine and control groups in patients undergoing general or spinal anesthesia. However, (,)-ketamine use led to a higher incidence of adverse reactions in patients under 40 years of age who underwent a Cesarean section under spinal anesthesia.
术后抑郁是手术后常见的并发症，会严重影响恢复和预后。新研究表明，（，）-氯胺酮是一种有效的抗抑郁药，能产生快速且持续的抗抑郁作用。然而，对于术中低剂量（，）-氯胺酮能否预防术后抑郁尚无共识。本研究旨在探讨术中低剂量（，）-氯胺酮预防术后抑郁症状的安全性、可行性及短期并发症。系统检索了Web of Science、Cochrane、PubMed和中国知网数据库（最后检索日期为2020年2月28日）以确定涉及氯胺酮的研究。进行敏感性和Meta回归分析以识别潜在混杂因素。使用Review Manager 5.3进行Meta分析。Meta分析共纳入13项研究（7项中文研究和6项英文研究），其中1148例患者接受（，）-氯胺酮治疗，874例患者接受其他治疗。两组间麻醉持续时间和失血量无显著差异，表明（，）-氯胺酮用于预防术后抑郁是安全的（比值比，OR：0.27；95%置信区间：-1.14至1.68；P = 0.71）。失血量（OR：-1.83；95%置信区间：-8.34至4.68；P = 0.58）、术后抑郁患者数量（95%置信区间：0.8 - 1.07；P = 0.08；（，）-氯胺酮组：对照组 = 12.9%：15.8%）以及术后并发症（OR：0.83，95%置信区间：0.44 - 1.58；P = 0.57；（，）-氯胺酮组：对照组 = 19.3%：19.3%）在各组间均相似。术中低剂量（，）-氯胺酮可缩短拔管时间（OR：-2.84；95%置信区间：-5.48至-0.21；P = 0.03）。在接受全身麻醉或脊髓麻醉的患者中，（，）-氯胺酮组和对照组预防抗抑郁作用无显著差异。然而，在40岁以下接受脊髓麻醉下剖宫产的患者中，使用（，）-氯胺酮导致不良反应发生率更高。
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