Li Hao-Yan, Xu Wen-Jing, Wang Ya-Mei, Xie Shuang, Wang Huan-Liang
Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.
Front Psychiatry. 2025 Apr 15;16:1476449. doi: 10.3389/fpsyt.2025.1476449. eCollection 2025.
Postoperative depression (POD) represents a serious complication in surgical patients, exacerbating morbidity and mortality rates while imposing a substantial economic burden on healthcare systems. Despite its widespread clinical use, the role of esketamine, an NMDA receptor antagonist with rapid antidepressant effects, remains understudied in perioperative settings. Therefore, we conducted a systematic review and meta-analysis to assess the efficacy of esketamine on postoperative depression. To evaluate the effect of esketamine on the incidence and severity of postoperative depression in different types of surgery by randomized controlled trial, investigate whether esketamine can effectively reduce the postoperative depression score and the incidence of postoperative depression in the short and long term after use, to promote the application of perioperative analgesia-antidepressant combination.
Searched PubMed, the Cochrane Library, the Web of Science, and Medline to identify randomized controlled trials using the drug of esketamine and analyzed the data using Review Manager 5.3.
We included a total of 8 randomized controlled trials involving 1724 patients who met the criteria. The meta-analysis revealed that esketamine treatment, compared with control groups, significantly reduced POD. Improvements were observed at 1 week (RD -0.09, 95% CI [-0.13, -0.05], P < 0.0001, I²=84%), 2 weeks (RD -0.08, 95% CI [-0.13, -0.03], P < 0.00001, I²=97%), and long-term follow-up (RD -0.06, 95% CI [-0.10, -0.02], P=0.0002, I²=79%).
Esketamine demonstrates efficacy in reducing POD incidence and severity, although its use is associated with an increased risk of adverse effects. Also, the method of drug injection, the duration of administration and the number of doses may have an effect on the results. Therefore, further exploration of appropriate dosing regimens and multi-modal strategies is necessary to mitigate adverse effects.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024506329.
术后抑郁（POD）是外科手术患者的一种严重并发症，会加剧发病率和死亡率，同时给医疗系统带来巨大经济负担。尽管艾司氯胺酮作为一种具有快速抗抑郁作用的N-甲基-D-天冬氨酸（NMDA）受体拮抗剂已在临床广泛应用，但其在围手术期的作用仍未得到充分研究。因此，我们进行了一项系统评价和荟萃分析，以评估艾司氯胺酮对术后抑郁的疗效。通过随机对照试验评估艾司氯胺酮对不同类型手术中术后抑郁的发生率和严重程度的影响，研究艾司氯胺酮在使用后的短期和长期内是否能有效降低术后抑郁评分及术后抑郁的发生率，以促进围手术期镇痛 - 抗抑郁联合应用。
检索PubMed、Cochrane图书馆、Web of Science和Medline，以识别使用艾司氯胺酮药物的随机对照试验，并使用Review Manager 5.3分析数据。
我们共纳入了8项涉及1724例符合标准患者的随机对照试验。荟萃分析显示，与对照组相比，艾司氯胺酮治疗显著降低了术后抑郁。在1周（风险差（RD）-0.09，95%置信区间（CI）[-0.13, -0.05]，P < 0.0001，I² = 84%）、2周（RD -0.08，95% CI [-0.13, -0.03]，P < 0.00001，I² = 97%）和长期随访（RD -0.06，95% CI [-0.10, -0.02]，P = 0.0002，I² = 79%）时均观察到改善。
艾司氯胺酮在降低术后抑郁发生率和严重程度方面显示出疗效，尽管其使用与不良反应风险增加有关。此外，药物注射方法、给药持续时间和剂量数量可能会对结果产生影响。因此，有必要进一步探索合适的给药方案和多模式策略以减轻不良反应。
