小剂量氯胺酮辅用于剖宫产椎管内麻醉临床疗效的meta分析  

Clinical effect of low-dose ketamine in assisting intraspinal anesthesia for cesarean section:a meta-analysis

作　　者：周鸿丽 王茂华 王晓斌 

机构地区：[1]西南医科大学临床医学院麻醉系,四川泸州646000 [2]西南医科大学附属医院麻醉科,四川泸州646000

出　　处：《西南医科大学学报》2017年第6期551-557,共7页Journal of Southwest Medical University

基　　金：国家自然科学基金(81271478)

摘　　要：目的:应用系统的文献回顾筛查对小剂量氯胺酮辅用于剖宫产椎管内麻醉术中减少寒战、术后抗抑郁及镇痛效果的临床疗效进行Meta分析。方法:系统检索万方、VIP、CNKI以及Sino Med等中文数据库和Pub Med、EBSCO、Cochrane Library等英文数据库。检索时限均从建库至2017年5月,筛选纳入小剂量氯胺酮辅用于剖宫产椎管内麻醉的临床随机对照试验,参照Cochrane Handbook质量评价标准以及偏倚风险评价标准,采用Revman 5.3软件对最终纳入研究进行Meta分析。结果:共纳入10项RCT临床研究,1 045例患者。Meta分析结果显示:氯胺酮组给药15 min后寒战发生例数少于对照组[OR=0.03,95%CI(0.01~0.11),P<0.0001,I2=0%];产后3~4 d氯胺酮组产妇抑郁发生例数少于对照组[OR=0.63,95%CI(0.41~0.94),P=0.03,I2=48%];氯胺酮组术后首次要求镇痛时间明显长于对照组[MD=62.25,95%CI(40.73~83.77),P=0.0002,I2=88%];术后恶心、呕吐、头痛的发生情况[OR=0.66,95%CI(0.40~1.09),P=0.10];[OR=0.96,95%CI(0.62~1.49),P=0.86];[OR=2.12,95%CI(0.22~20.13),P=0.51],P>0.05,差异无统计学意义。结论:小剂量氯胺酮辅用于剖宫产椎管内麻醉期间可减少术中寒战、术后3~4 d抑郁发生率及延长术后镇痛时间,且无明显不良反应。Objective To investigate the clinical effect of low- dose ketamine to reduce chill, prevent depression, and ease pain in assisting intraspinal anesthesia for cesarean section through a meta - analysis. Methods： Chinese databases including Wanfang Data, VIP, CNKI, and SinoMed and English databases including PubMed, EBSCO, and Cochrane Library were systematically searched for articles published up to May 2017. The randomized controlled trials （RCTs） on low-dose ketamine used in intraspinal anesthesia for cesarean section were screened out and included in the meta-analysis. Assessment of Study Quality in Cochrane Handbook and the criteria for evaluating the risk of bias were used, and Revman 5.3 software was used for the meta-analysis. Results： A total of 10 RCTs with 1 045 patients were included. The results of the meta-analysis showed that the ketamine group had a significantly lower number of patients who experienced chills at 15 minutes after administration than the control group （odds ratio = 0.03, 95 % confidence interval： 0.01 ？0.11, P 〈 0.0001, I2 = 0% ）. Compared with the control group, the ketamine group had a significantly lower number of patients who developed depression at 3-4 days after delivery （OR = 0.63, 9 5 % CI： 0.41 ~ 0.94, P = 0.03, I2 = 48%） and a significantly longer time to first requirement for analgesia after surgery （MD = 62.25, 95% CI： 40.73 ~ 83.77, the incidence rates of postoperative nausea （OR = 0.66, 9 5 % CI： 0.40 ~ 1.09, P = 0.10）, vomiting （OR = 0.96, 95% CI： 0.62~1.49, P = 0.86）, and headache （OR = 2.12, 9 5 % CI： 0.22 ~ 20.13, P = 0.51） between the two groups. Conclusions： Low-dose ketamine used to assist intraspinal anesthesia for cesarean delivery can reduce the incidence rates of intraoperative chills and depression at 3 ~ 4 days after surgery and prolong the time to analgesia, with few adverse reactions.

关 键 词：氯胺酮 剖宫产 椎管内麻醉 META分析 

分 类 号：R614[医药卫生—麻醉学]