围手术期使用艾司氯胺酮对接受扁桃体切除术和腺样体切除术儿童的急性谵妄的影响：一项随机对照试验的系统评价和荟萃分析
Effect of perioperative esketamine use on emergency delirium in children undergoing tonsillectomy and adenoidectomy: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Liu Junfeng, Liu Jinming, Sun Hong, Cheng Xue, Wang Chunhui, Lei Daoyun, Han Chao
机构信息
Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China.
Department of Anesthesiology, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China.
出版信息
Front Med (Lausanne). 2025 Jan 29;12:1505408. doi: 10.3389/fmed.2025.1505408. eCollection 2025.
BACKGROUND
Emergence delirium(ED) is a common postoperative complication in children undergoing tonsillectomy and adenoidectomy under general anesthesia. There is no high-quality evidence on the relationship between esketamine and ED. The systematic review and meta-analysis was performed to investigate the effect of perioperative esketamine use on ED in children undergoing tonsillectomy and adenoidectomy.
METHOD
We searched Embase, The Cochrane Library, PubMed, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, VIP, and SinoMed from inception to 1 September, 2024. Two evaluators identified randomized controlled trials comparing perioperative use of esketamine with placebo or other drugs in children undergoing tonsillectomy and adenoidectomy. Incidence of ED was the primary outcome of the study. Data synthesis was performed by using Review Manager 5.4 software.
RESULTS
Twenty-three relevant studies involving a total of 1,996 children were identified. Perioperative use of esketamine reduced the incidence of ED in children undergoing tonsillectomy and adenoidectomy (RR = 0.33, 95% CI: [0.25, 0.44], < 0.00001, = 0%). Scores of ED were lower in the esketamine group than in the control group (SMD = -1.20, 95% CI: [-1.56,-0.84], < 0.00001, = 88%). Children in the esketamine group have lower postoperative pain scores (SMD = -0.51, 95% CI: [-0.80,-0.39], < 0.00001, = 74%). Esketamine was also associated with a lower incidence of adverse events (RR = 0.75, 95% CI: [0.57, 0.99], = 0.04, = 62%). We also found that the use of esketamine reduced the length of stay in the post-anesthetic care unit (PACU) but had no effect on the time to extubation.
CONCLUSION
Perioperative use of esketamine could significantly reduce the incidence of ED in children undergoing tonsillectomy and adenoidectomy. However, the optimal dose and timing of esketamine administration for preventing ED remains to be explored.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=558560, PROSPERO: CRD42024558560.
背景
苏醒期谵妄（ED）是全身麻醉下接受扁桃体切除术和腺样体切除术儿童常见的术后并发症。关于艾司氯胺酮与苏醒期谵妄之间的关系，尚无高质量证据。本系统评价和荟萃分析旨在探讨围手术期使用艾司氯胺酮对接受扁桃体切除术和腺样体切除术儿童苏醒期谵妄的影响。
方法
检索了从数据库建库至2024年9月1日的Embase、Cochrane图书馆、PubMed、MEDLINE、Web of Science、中国知网（CNKI）、万方、维普和中国生物医学文献数据库（SinoMed）。两名评估人员识别比较围手术期使用艾司氯胺酮与安慰剂或其他药物的随机对照试验，这些试验涉及接受扁桃体切除术和腺样体切除术的儿童。苏醒期谵妄的发生率是本研究的主要结局。使用Review Manager 5.4软件进行数据合成。
结果
共纳入23项相关研究，涉及1996名儿童。围手术期使用艾司氯胺酮降低了接受扁桃体切除术和腺样体切除术儿童苏醒期谵妄的发生率（RR = 0.33，95%CI：[0.25, 0.44]，P < 0.00001，I² = 0%）。艾司氯胺酮组的苏醒期谵妄评分低于对照组（SMD = -1.20，95%CI：[-1.56, -0.84]，P < 0.00001，I² = 88%）。艾司氯胺酮组儿童术后疼痛评分更低（SMD = -0.51，95%CI：[-0.80, -0.39]，P < 0.00001，I² = 74%）。艾司氯胺酮还与较低的不良事件发生率相关（RR = 0.75，95%CI：[0.57, 0.99]，P = 0.04，I² = 62%）。我们还发现，使用艾司氯胺酮可缩短麻醉后监护病房（PACU）的住院时间，但对拔管时间无影响。
结论
围手术期使用艾司氯胺酮可显著降低接受扁桃体切除术和腺样体切除术儿童苏醒期谵妄的发生率。然而，预防苏醒期谵妄的艾司氯胺酮最佳剂量和给药时机仍有待探索。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=558560，PROSPERO：CRD42024558560
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