氯胺酮对术后神经认知障碍的影响：一项系统评价和荟萃分析。

Effect of Ketamine on Postoperative Neurocognitive Disorders: A Systematic Review and Meta-Analysis.

作者信息

Viderman Dmitriy, Aubakirova Mina, Nabidollayeva Fatima, Yegembayeva Nurgul, Bilotta Federico, Badenes Rafael, Abdildin Yerkin

机构信息

Department of Biomedical Sciences, Nazarbayev University School of Medicine (NUSOM), Kerei and Zhanibek Khandar Str. 5/1, Astana 010000, Kazakhstan.

Department of Anesthesiology and Intensive Care, National Research Oncology Center, Astana 010000, Kazakhstan.

出版信息

J Clin Med. 2023 Jun 27;12(13):4314. doi: 10.3390/jcm12134314.

BACKGROUND

Neurocognitive alterations in the perioperative period might be caused by a wide variety of factors including pain, blood loss, hypotension, hypoxia, micro- and macroemboli, cardiopulmonary bypass (CPB), reperfusion damage, and surgery itself, and all are risk factors for developing postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). The objective of this study was to evaluate the effect of ketamine on neurocognitive dysfunction after anesthesia.

METHODS

We conducted a meta-analysis of randomized controlled trials (RCTs) comparing ketamine use (experimental group) with placebo (controls).

RESULTS

The model favors the control group over the experimental group in terms of frequency of hallucinations (the risk ratio with 95% CI is 1.54 [1.09, 2.19], -value = 0.02), the number of patients readmitted within 30 days (RR with 95% CI is 0.25 [0.09, 0.70]), and the number of adverse events (overall RR with 95% CI is 1.31 [1.06, 1.62]). In terms of morphine consumption, the model favors the experimental group.

CONCLUSION

There was no statistically significant difference in incidences of postoperative delirium, vasopressor requirement, and fentanyl consumption between the ketamine and control groups. However, hallucinations were more frequently reported in the ketamine group.

背景

围手术期的神经认知改变可能由多种因素引起，包括疼痛、失血、低血压、缺氧、微栓子和大栓子、体外循环（CPB）、再灌注损伤以及手术本身，而所有这些都是发生术后谵妄（POD）和术后认知功能障碍（POCD）的危险因素。本研究的目的是评估氯胺酮对麻醉后神经认知功能障碍的影响。

方法

我们对比较氯胺酮使用（实验组）与安慰剂（对照组）的随机对照试验（RCT）进行了荟萃分析。

结果

在幻觉发生率方面（风险比及95%置信区间为1.54 [1.09, 2.19]，P值 = 0.02）、30天内再次入院的患者数量方面（风险比及95%置信区间为0.25 [0.09, 0.70]）以及不良事件数量方面（总体风险比及95%置信区间为1.31 [1.06, 1.62]），模型显示对照组优于实验组。在吗啡消耗量方面，模型显示实验组更优。