国际麻醉学与复苏杂志   2022, Issue (1): 0-0
    
静脉注射氯胺酮预防儿童苏醒期躁动的系统评价
亚力·亚森, 于晓东, 王佳玲, 李孟, 房志远, 叶建荣1()
1.新疆医科大学第一附属医院
Intravenous ketamine for emergence agitation in children: a systematic review and Meta‑analysis
 全文:
摘要：

目的 评估静脉注射氯胺酮预防儿童苏醒期躁动（emergence agitation, EA）的临床应用效果。 方法 检索PubMed、the Cochrane Library、中国知网、万方数据知识服务平台（WanFang）、中国生物医学文献服务系统（SinoMed），查找建库至2020年3月静脉注射氯胺酮用于儿童EA的随机对照试验；文献中研究对象为全身麻醉下行择期手术/检查的儿童，性别不限，认知功能和精神状态无异常；文献中有氯胺酮组和对照组，氯胺酮组儿童于围手术期静脉注射氯胺酮，对照组儿童使用安慰剂对照或空白对照。检索后进行文献筛查、基本资料提取和偏倚风险评估。结局指标包括EA发生率、术后恶心呕吐（postoperative nausea and vomiting, PONV）发生率、低氧饱和度发生率、PACU停留时间、术后疼痛评分。采用RevMan 5.3软件进行Meta分析。 结果 最终纳入Meta分析文献19篇，共1 532例患者。Meta分析结果显示：氯胺酮组儿童EA发生率明显低于对照组［相对危险度（relative risk, RR）=0.38，95%CI（0.31，0.45），P<0.001］，两组儿童PONV发生率差异无统计学意义［比值比（odds ratio, OR）=1.19，95%CI（0.81，1.75），P=0.380］，两组儿童低氧饱和度发生率差异无统计学意义［OR=0.79，95%CI（0.38，1.67），P=0.540］，两组儿童PACU停留时间差异无统计学意义［均数差（mean difference, MD）=1.44，95%CI（−0.52，3.40），P=0.150］，氯胺酮组儿童术后疼痛评分明显低于对照组［MD=−2.13，95%CI（−3.34，−0.91），P<0.001］。基于EA发生率的漏斗图提示发表偏倚较小。 结论 静脉注射氯胺酮能够降低儿童EA的发生率，不增加PONV和低氧血症发生率，但对术后疼痛和PACU停留时间的影响尚待评估。
关键词： 氯胺酮； 苏醒期躁动； 儿童； Meta分析
Abstract:

Objective To evaluate the clinical effectiveness of intravenous ketamine for emergence agitation (EA) in children. Methods PubMed, the Cochrane Library, CNKI, WanFang, and SinoMed database were searched from database establishment to Match 2020 for randomized controlled trials (RCT) about intravenous ketamine for EA in children. The subjects in the literature search were children who were scheduled to undergo surgery/examination under general anesthesia, regardless of gender, without abnormalities in cognitive function and mental status. Clinical data were collected from the ketamine group and the control group included in the literature. Children in the ketamine group were intravenously injected with ketamine during the perioperative period, while those in the control group received placebo or blank control. After retrieval, literature screening, data extraction and quality evaluation were performed. The outcomes included the incidences of EA, postoperative nausea and vomiting (PONV), and low oxygen saturation, as well as the length of post anesthesia care unit (PACU) stay and postoperative pain score. The Meta‑analysis was conducted by RevMan 5.3. Results A total of 19 articles involving 1 532 patients were included. The Meta‑analysis showed that the incidence of EA in the ketamine group was significantly lower than that in the control group [relative risk (RR)=0.38, 95% confidence interval (CI) (0.31, 0.45), P<0.001]. There was no statistical difference in the incidence of PONV between the two groups [odds ratio (OR) =1.19, 95%CI (0.81, 1.75), P=0.380]. There was no statistical difference in the incidence of low oxygen saturation between the two groups [OR=0.79, 95%CI (0.38, 1.67), P=0.540]. There was no significant difference in the length of PACU time between the two groups [mean difference (MD)=1.44, 95%CI (−0.52, 3.40), P=0.150]. The postoperative pain scores of children in the ketamine group were significantly lower than those in the control group [MD=−2.13, 95%CI (−3.34, −0.91), P<0.001]. The funnel plot in the Meta‑analysis based on EA incidence suggested a small publication bias. Conclusions Intravenous ketamine can reduce the incidence of EA in children, and cannot increase the incidence of PONV and hypoxemia, but the effect on postoperative pain and the length of PACU stay remains to be evaluated.
Key words: Ketamine; Emergence agitation; Children; Meta‑analysis