围手术期艾司氯胺酮对围手术期神经认知功能障碍的影响：一项随机对照研究的系统评价和荟萃分析
Impact of perioperative esketamine on the perioperative neurocognitive dysfunction: a systematic review and meta-analysis of randomised controlled studies.
作者信息
Su Xuesen, Chen Lu, Zhao Yanan, Li Chao, Liu Shufang, Wang Zixuan, Zhu Jiayu, Yuan Xin, Tian Yihe, Tian Shouyuan
机构信息
The Anesthesiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China.
Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, China.
出版信息
BMJ Open. 2025 May 21;15(5):e095695. doi: 10.1136/bmjopen-2024-095695.
OBJECTIVES
The effect of esketamine on perioperative neurocognitive dysfunction (PND) remains controversial. This systematic review and meta-analysis aimed to evaluate the impact of perioperative esketamine administration on PND.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, EMBASE, Web of Science and Cochrane Library were searched from their inception to 25 April 2024.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included the randomised controlled trials (RCTs) that compared single or continuous intravenous infusion of esketamine to saline among adult surgical patients without pre-existing neurocognitive disorders.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently extracted pertinent information from the included studies. Risk of bias was assessed using Cochrane's risk of bias criteria. Risk ratios (RRs) and their corresponding 95% CIs were synthesised using a random-effects model. The overall evidence quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework.
RESULTS
10 RCTs were included in our meta-analysis, involving 854 surgical patients. Perioperative esketamine was associated with a reduced risk of postoperative delirium (POD) (relative risk (RR): 0.46, 95% CI: 0.30 to 0.71, p<0.001) and delayed neurocognitive recovery (dNCR) (RR: 0.41, 95% CI: 0.21 to 0.78, p<0.001). However, no statistically significant difference was found in the risk of postoperative neurocognitive disorder (post-NCD) at 3 months postsurgery between the esketamine and control groups (RR: 0.57, 95% CI: 0.19 to 1.73, p=0.40). Additionally, pain severity was reduced on postoperative day 1, with no difference in the risk of adverse events or length of hospital stay.
CONCLUSION
Perioperative esketamine reduces the risk of short-term PND, including POD and dNCR, without significantly affecting the incidence of adverse events or length of hospital stay. However, no significant differences were observed in the risk of post-NCD at 3 months following surgery. This systematic review and meta-analysis offers valuable data for PND research and clinical drug intervention strategies.
PROSPERO REGISTRATION NUMBER
CRD42024538438.
目的
艾司氯胺酮对围手术期神经认知功能障碍（PND）的影响仍存在争议。本系统评价和荟萃分析旨在评估围手术期使用艾司氯胺酮对PND的影响。
设计
系统评价和荟萃分析。
数据来源
检索了PubMed、EMBASE、科学网和Cochrane图书馆自建库至2024年4月25日的文献。
研究选择的纳入标准
我们纳入了在无既往神经认知障碍的成年外科患者中，比较单次或持续静脉输注艾司氯胺酮与生理盐水的随机对照试验（RCT）。
数据提取与合成
两名研究者独立从纳入研究中提取相关信息。使用Cochrane偏倚风险标准评估偏倚风险。采用随机效应模型合成风险比（RR）及其相应的95%置信区间（CI）。使用推荐分级评估、制定和评价框架对总体证据质量进行评估。
结果
我们的荟萃分析纳入了10项RCT，涉及854例外科患者。围手术期使用艾司氯胺酮与术后谵妄（POD）风险降低相关（相对风险（RR）：0.46，95%CI：0.30至0.71，p<0.001）以及神经认知恢复延迟（dNCR）风险降低相关（RR：0.41，95%CI：0.21至0.78，p<0.001）。然而，艾司氯胺酮组与对照组在术后3个月时术后神经认知障碍（post-NCD）风险方面未发现统计学显著差异（RR：0.57，95%CI：0.19至1.73，p=0.40）。此外，术后第1天疼痛严重程度降低，不良事件风险或住院时间无差异。
结论
围手术期使用艾司氯胺酮可降低短期PND风险，包括POD和dNCR，且不显著影响不良事件发生率或住院时间。然而，术后3个月时post-NCD风险未观察到显著差异。本系统评价和荟萃分析为PND研究和临床药物干预策略提供了有价值的数据。
PROSPERO注册号：CRD42024538438。
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