围术期应用氯胺酮对剖宫产产妇产后抑郁影响的Meta分析

Effect of ketamine on postpartum depression after caesarean surgery: a meta-analysis

中文关键词: 氯胺酮  剖宫产  产后抑郁  Meta分析

英文关键词: Ketamine  Caesarean surgery  Postpartum depression  Meta-analysis

中文摘要:

      
目的 评价围术期应用氯胺酮对剖宫产产妇产后抑郁（PD）的影响。
方法 通过检索Pubmed、Embase、Cochrane library、Web of Science、中国生物医学文献数据库、万方、知网和维普等数据库，检索时间为建库至2020年9月，收集有关围术期应用氯胺酮对剖宫产产妇PD影响的随机对照试验，文献进行筛选后，提取数据，并对文献进行质量评价。应用RevMan 5.3软件进行统计学分析。
结果 共纳入8项RCT研究，共计2 000例患者，根据是否使用氯胺酮将患者分为2组：氯胺酮组和对照组。其中氯胺酮组1 059例，对照组941例。氯胺酮组术后短期内（2~4 d）的PD发生率明显低于对照组（RR=0.66， 95%CI 0.53~0.82， P<0.05），术中恶心呕吐（RR=2.25，95%CI 1.52~3.33，P<0.05）、头晕（RR=5.19，95%CI 1.14~23.70，P<0.05）、幻觉（RR=13.03，95%CI 2.49~68.27，P<0.05）的发生率明显高于对照组。
结论 围术期应用氯胺酮可降低剖宫产术后短期PD的发生率，但有增加术中不良反应的风险。

英文摘要:

      
Objective To evaluate the effect of ketamine on postpartum depression (PD) after caesarean section.
Methods The electronic database of Pubmed, Embase, Cochrane library, Web of Science, China Biology Medicine disc, WanFang, CNKI, VIP were searched, from inception to September 2020. Randomized controlled trials (RCTs) which evaluated the effect of ketamine used in perioperative period on PD after caesarean surgery were included. Reviewers screened the studies, performed quality assessment and conducted data extraction. RevMan 5.3 was used for meta-analysis.
Results Eight RCTs including 2 000 patients were enrolled. Patients were divided into two groups according to whether ketamine was used or not. Among them, 1 059 were in ketamine group, 941 were in control group. Compared with control group, the incidence of PD in short-term (RR = 0.66, 95% CI 0.53-0.82, P < 0.05) was significantly lower in ketamine group. The incidence of nausea and vomiting (RR = 2.25, 95% CI 1.52-3.33, P < 0.05), dizziness (RR = 5.19, 95% CI 1.14-23.70, P < 0.05)and hallucination (RR = 13.03, 95 % CI 2.49-68.27, P < 0.05) during the operation were significantly higher in ketamine group than in placebo group.
Conclusion Ketamine used in perioperative period could decrease the incidence of PD in short term. However, ketamine could increase the incidence of adverse events in operation．