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预防性使用艾司氯胺酮对术后抑郁和生活质量的影响：一项荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：李奕 编辑：杨荣峰 审校：曹莹
这项系统性综述和荟萃分析的目的是评估预防性使用艾司氯胺酮对患者术后抑郁和生活质量的影响。
作者在电子数据库，包括PubMed，EMBASE，Cochrane Central Register of Controlled Trials，Web of Science中搜索了所有关于术后患者使用艾司氯胺酮的文章，直到2023年6月。纳入的研究通过随机对照试验比较了使用艾司氯胺酮和安慰剂对术后抑郁和患者生活质量的影响。结果测量包括术后抑郁和可以反映对患者术后影响的指标。在Review Manager 5.4工具中采用了Cochrane风险偏倚工具来评估偏倚风险。
该研究包括了总共11项随机对照试验，涉及1447名参与者。这项荟萃分析显示，预防性使用艾司氯胺酮可以缓解术后抑郁症状（标准化平均差异[SMD]：-0.61；95%置信区间[CI]：-0.96至-0.25；P=0.0008）和发生率（相对风险[RR]：0.37；95%[CI]：0.22至0.62；P=0.0001），减少了术后抑郁、焦虑和慢性疼痛的发生。此外，它还改善了术后睡眠质量和患者术后的生活质量。
术前和麻醉期间预防性使用艾司氯胺酮对改善术后生活质量有显著益处。它可以有效缓解术后抑郁、焦虑和慢性疼痛，并提高睡眠质量。
原始文献来源：Guoweng Niu , Xiaozhu Zheng , Bigao Deng, et al. The effects of prophylactic use of esketamine on postoperative depression and quality of life: a meta-analysis.[J].Minerva Anestesiol. 2024 Apr;90(4):321-329.
The effects of prophylactic use
of esketamine on postoperative depression
and quality of life: a meta-analysis
Abstract
Introduction: The aim of this systemic review and meta-analysis was to assess the impact of prophylactic use of esketamine on postoperative depression and quality of life in patients.
Evidence acquisition: We searched for all articles on esketamine in patients after surgury in electronic data bases, including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, up to the June 2023.The included studies compared the impact of using esketamine and placebo on postoperative depression and quality of life in patients through randomized controlled trials. The outcome measurements consist of postoperative depression and indicators that can reflect the impact on patients' post Cochrane Risk of Bias tool in Review Manager 5.4 tool was adopted to assess the risk of bias.
Evidence synthesis: The study included a total of 11 randomized controlled trials with 1447 participants. This meta-analysis demonstrated that the prophylactic use of esketamine alleviated postoperative depressive symptoms (standardized mean difference [SMD]: -0.61; 95% confidence interval [CI]: -0.96 to -0.25; P=0.0008) and incidence (relative risk [RR]:0.37;95% [CI]: 0.22 to 0.62; P=0.0001), reducing the occurrence of postoperative depression, anxiety, and chronic pain. Additionally, it improved postoperative sleep quality and enhanced the postoperative quality of life for patients.
Conclusions: Prophylactic use of esketamine during the preoperative and anesthesia period has shown significant benefits in improving postoperative quality of life. It can effectively alleviate postoperative depression, anxiety, and chronic pain, as well as enhance sleep quality.
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