氯胺酮对择期手术全麻患者术后谵妄的影响：一项随机对照试验的荟萃分析。

Effect of esketamine on postoperative delirium in general anesthesia patients undergoing elective surgery: a meta-analysis of randomized controlled trials.

机构信息

Department of Anesthesiology, Central Hospital of Dalian University of Technology, No. 826 Southwest Road, Shahekou District, Dalian, Liaoning Province, China.

China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China.

出版信息

BMC Anesthesiol. 2024 Nov 28;24(1):442. doi: 10.1186/s12871-024-02833-x.

BACKGROUND

Postoperative delirium is a common neurological complication, especially in older patients undergoing surgery, which is closely related to the poor prognosis of patients. The objective was to investigate the effects of esketamine on postoperative delirium in patients with general anesthesia.

METHODS

The databases of PubMed, Embase, Cochrane Library and the Chinese National Knowledge Infrastructure were searched for all available randomised controlled trials on the effects of esketamine induction on postoperative delirium in patients undergoing elective general anesthesia from inception until April 21, 2024. We used RevMan5.4 software for data analysis. Dichotomous data was analyzed by risk ratios(RR) with a 95% confidence interval(CI), and continuous data by mean differences(MD). We also evaluated the risk of literature bias using the Cochrane Bias Risk Assessment tool.

RESULTS

We included a total of 17 randomized controlled trials, including 1286 patients undergoing elective general anesthesia. In 17 studies, esketamine significantly reduced the incidence of postoperative delirium (RR: 0.43; 95%CI: 0.33 ~ 0.57; p < 0.001). Five studies examined the incidence of postoperative adverse events (nausea, vomiting, dizziness and resporatory depression) and showed no statistically significant difference between the esketamine group and the control group (normal saline or dexmedetomidine) (RR: 0.82; 95%CI: 0.65 ~ 1.03; p = 0.08). In addition, this study found that the esketamine group had a lower incidence of hypotension (RR: 0.24; 95%CI: 0.12 ~ 0.48; p < 0.001) and a lower score on the visual analogue scale 24 h after surgery (MD: -0.44; 95%CI: -0.54 ~ -0.33; p < 0.001).

CONCLUSION

According to our meta-analysis, the use of esketamine during anesthesia induction significantly reduced the incidence of postoperative delirium in patients undergoing elective general anesthesia without increasing the incidence of postoperative adverse reactions.

背景

术后谵妄是一种常见的神经并发症，尤其在接受手术的老年患者中更为常见，与患者的预后不良密切相关。本研究旨在探讨麻醉诱导时使用氯胺酮对接受择期全身麻醉患者术后谵妄的影响。

方法

检索 PubMed、Embase、Cochrane 图书馆和中国知网（CNKI）数据库，检索所有关于麻醉诱导时使用氯胺酮对接受择期全身麻醉患者术后谵妄影响的随机对照试验，检索时间截至 2024 年 4 月 21 日。使用 RevMan5.4 软件进行数据分析。二分类数据采用比值比（RR）及其 95%置信区间（CI）表示，连续性数据采用均数差（MD）表示。采用 Cochrane 偏倚风险评估工具评估文献偏倚风险。

结果

共纳入 17 项随机对照试验，共计 1286 例接受择期全身麻醉的患者。17 项研究中，氯胺酮组术后谵妄发生率显著低于对照组（RR：0.43；95%CI：0.330.57；p<0.001）。5 项研究评估了术后不良反应（恶心、呕吐、头晕和呼吸抑制）的发生率，氯胺酮组与对照组（生理盐水或右美托咪定）比较，差异无统计学意义（RR：0.82；95%CI：0.651.03；p=0.08）。此外，本研究还发现，氯胺酮组低血压发生率较低（RR：0.24；95%CI：0.12~~0.48；p<0.001），术后 24 h 视觉模拟评分较低（MD：-0.44；95%CI：-0.54~~-0.33；p<0.001）。