氯胺酮对术后导尿管相关膀胱不适疗效及安全性的Meta分析
Meta-Analysis of the Efficacy and Safety of Ketamine on Postoperative Catheter-Related Bladder Discomfort.
作者信息
Lu Youyi, Li Qi, Wang Yunqiang, Zhou Zhongbao, Zhang Dongxu, Bao Yiping, Wu Jitao, Cui Yuanshan
机构信息
Department of Urology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Department of Endocrinology, Yantai City Municipal Government Hospital, Yantai, China.
出版信息
Front Pharmacol. 2022 Jun 27;13:816995. doi: 10.3389/fphar.2022.816995. eCollection 2022.
We conducted meta-analysis to demonstrate the efficacy and safety of ketamine on postoperative catheter-related bladder discomfort (CRBD). A systematic search was performed through PubMed, Embase, and Cochrane Library to identify all randomized controlled trials that used ketamine in postoperative CRBD. This study was carried out by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We used RevMan version 5.3.0. to analyze the data. Five RCTs involving 414 patients were included in the analysis. The incidence and severity of postoperative CRBD were assessed at 0, 1, 2, and 6 h. According to our results of meta-analysis, ketamine reduced the incidence of postoperative CRBD at 2 h (RR 0.39; 95% CI, 0.21-0.71; = 0.002, I = 40%) and 6 h (RR 0.29; 95% CI, 0.16-0.50; < 0.0001, I = 0%) significantly; however, there were no statistical differences at 0 h (RR 0.81; 95% CI, 0.35-1.88; = 0.62, I = 96%) and 1 h (RR 0.57; 95% CI, 0.13-2.54; = 0.46, I = 97%). In two studies, we compared the incidence of moderate-to-severe CRBD between groups according to the scaling system (none, mild, moderate, and severe), and data are presented as numbers. Patients in the ketamine group showed a significantly lower severity of CRBD than those in the placebo group at 1 h (RR 0.09; 95% CI, 0.03-0.31; = 0.0001) and 2 h (RR 0.06; 95% CI, 0.01-0.44; = 0.005). In contrast, there were no meaningful differences between the two groups in the severity of CRBD at 0 h (RR 0.18; = 0.84) or 6 h (RR 0.20; 95% CI, 0.03-1.59; = 0.13). There were no meaningful differences on the rate of adverse events between the ketamine group and control group, mainly including postoperative nausea and vomiting (RR 1.24; 95% CI, 0.89-1.72; = 0.21), diplopia (RR 3.00; 95% CI, 0.48-18.67; = 0.24), and hallucination (RR 3.00; 95% CI, 0.32-28.24; = 0.34). Our meta-analysis demonstrated that a sub-hypnotic dose of ketamine administration can reduce the incidence and severity of postoperative CRBD without causing evident side effects.
我们进行了荟萃分析，以证明氯胺酮对术后导尿管相关膀胱不适（CRBD）的有效性和安全性。通过PubMed、Embase和Cochrane图书馆进行了系统检索，以识别所有在术后CRBD中使用氯胺酮的随机对照试验。本研究按照系统评价和荟萃分析的首选报告项目进行。我们使用RevMan 5.3.0版本来分析数据。分析纳入了5项涉及414例患者的随机对照试验。在术后0、1、2和6小时评估术后CRBD的发生率和严重程度。根据我们的荟萃分析结果，氯胺酮在术后2小时（RR 0.39；95%CI，0.21 - 0.71；P = 0.002，I² = 40%）和6小时（RR 0.29；95%CI，0.16 - 0.50；P < 0.0001，I² = 0%）显著降低了术后CRBD的发生率；然而，在0小时（RR 0.81；95%CI，0.35 - 1.88；P = 0.62，I² = 96%）和1小时（RR 0.57；95%CI，0.13 - 2.54；P = 0.46，I² = 97%）没有统计学差异。在两项研究中，我们根据分级系统（无、轻度、中度和重度）比较了组间中重度CRBD的发生率，并以数字形式呈现数据。氯胺酮组患者在1小时（RR 0.09；95%CI，0.03 - 0.31；P = 0.0001）和2小时（RR 0.06；95%CI，0.01 - 0.44；P = 0.005）时CRBD的严重程度明显低于安慰剂组。相比之下，两组在0小时（RR 0.18；P = 0.84）或6小时（RR 0.20；95%CI，0.03 - 1.59；P = 0.13）时CRBD的严重程度没有显著差异。氯胺酮组和对照组在不良事件发生率上没有显著差异，主要包括术后恶心和呕吐（RR 1.24；95%CI，0.89 - 1.72；P = 0.21）、复视（RR 3.00；95%CI，0.48 - 18.67；P = 0.24）和幻觉（RR 3.00；95%CI，0.32 - 28.24；P = 0.34）。我们的荟萃分析表明，亚催眠剂量的氯胺酮给药可以降低术后CRBD的发生率和严重程度，且不会引起明显的副作用。
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