氯胺酮在难治性及超难治性癫痫持续状态中的应用：一项系统评价。
完整摘要 · 中文译文
背景：难治性癫痫持续状态（RSE）和超难治性癫痫持续状态（SRSE）与显著的发病率、死亡率和重症监护需求相关。氯胺酮因其N-甲基-D-天冬氨酸受体拮抗作用及相对有利的血流动力学特征，已成为一种潜在的辅助治疗药物。 目的：评估氯胺酮在RSE和SRSE终止中的有效性和安全性。 方法：本系统综述遵循PRISMA 2020指南，并在PROSPERO注册（CRD42024625516）。检索PubMed、Scopus、Web of Science和Biblioteca Virtual en Salud数据库，检索时间从建库至2025年11月20日。两名独立评审员筛选研究，提取临床、治疗、脑电图、血流动力学和生存数据，并使用美国国立卫生研究院质量评估工具评估偏倚风险。由于存在显著异质性，未进行荟萃分析。 结果：共纳入12项研究，涉及491例患者。氯胺酮通常在多种抗癫痫药物和静脉麻醉药治疗失败后作为多模式治疗的一部分给药。输注速率范围为0.05 mg/kg/h至10.5 mg/kg/h，治疗持续时间范围为6小时至29天。研究定义的氯胺酮启动后应答率从完全停止脑电图癫痫发作的43.3%到RSE/SRSE总体终止的100%不等；然而，最高的估计值往往反映的是联合治疗而非单用氯胺酮。短期或住院生存率为45.8%至81.8%。即刻血流动力学恶化 n 似乎不常见，尽管归因受到基线不稳定和合并治疗的限制。 结论：含氯胺酮的方案与难治性癫痫持续状态/超难治性癫痫持续状态（RSE/SRSE）中具有临床意义的癫痫发作减少或停止相关，未发现一致的急性血流动力学损害信号。然而，氯胺酮对持续癫痫控制、生存和功能恢复的独立效应仍不确定。需要采用标准化给药、时机和结局定义的前瞻性比较研究。 系统综述注册：PROSPERO 注册号 CRD42024625516。
完整摘要 · 英文原文
BACKGROUND: Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are associated with substantial morbidity, mortality, and intensive care requirements. Ketamine has emerged as a potential adjunct because of its N-methyl-D-aspartate receptor antagonism and relatively favourable haemodynamic profile. OBJECTIVE: To evaluate the effectiveness and safety of ketamine in RSE and SRSE resolution. METHODS: This systematic review followed PRISMA 2020 and was registered in PROSPERO (CRD42024625516). PubMed, Scopus, Web of Science, and Biblioteca Virtual en Salud were searched from inception to 20 November 2025. Two independent reviewers screened studies, extracted clinical, therapeutic, electroencephalographic, haemodynamic, and survival data, and assessed risk of bias using National Institutes of Health quality assessment tools. Meta-analysis was not performed because of substantial heterogeneity. RESULTS: Twelve studies comprising 491 patients were included. Ketamine was generally administered as part of multimodal therapy after failure of several antiseizure medications and intravenous anaesthetics. Infusion rates ranged from 0.05 mg/kg/h to 10.5 mg/kg/h, and treatment duration ranged from 6 h to 29 days. Study-defined response rates following ketamine initiation ranged from 43.3% for complete electrographic seizure cessation to 100% for overall RSE/SRSE resolution; however, the highest estimates often reflected combined treatment rather than ketamine alone. Short-term or hospital survival ranged from 45.8% to 81.8%. Immediate haemodynamic deterioration appeared uncommon, although attribution was limited by baseline instability and concomitant therapy. CONCLUSION: Ketamine-containing regimens were associated with clinically relevant seizure reduction or cessation in RSE/SRSE, without a consistent signal of acute haemodynamic harm. However, the independent effect of ketamine on sustained seizure control, survival, and functional recovery remains uncertain. Prospective comparative studies using standardised dosing, timing, and outcome definitions are required. SYSTEMATIC REVIEW REGISTRATION: PROSPERO identifier CRD42024625516.