氯胺酮导致下尿路症研究进展与相关动物试验的系统评价

目的探讨氯胺酮导致下尿路症状的临床症状案例报告相关研究的病因以及治疗方案,并对动物模型可靠性进行系统评价。方法计算机检索Pubmed,Embase,Elsevier,CNKI和Google Scholar,查找所有研究氯胺酮导致下尿路症状的文献,包括动物实验,检索时限为2007-01-01/2013-10-30。同时手检纳入文献的参考文献,按纳入排除标准由两人独立进行RCT的筛选,资料提取和质量评价后,进行定性分析。并采用STAIR清单和CAMARADES清单进行质量评价。结果 12篇个案均报道氯胺酮导致下尿路症状,主要临床表现为尿频、尿急、耻骨上疼痛。共纳入3个动物实验,且动物试验的方法学质量均不高,由于纳入研究的数量少和研究方法间的差异,本系统评价不适合采用Meta分析,有限的证据表明氯胺酮会导致小鼠膀胱壁增厚。结论本系统评价显示并没有可信服的证据证明动物试验在研究氯胺酮导致下尿路症状的可靠性。

Systematic Review on Ketamine Induced Lower Urinary Tract Symptoms and Relevant Animal Experiments

Objective To explore the animal model,cause and treatment of the case reports for ketamine associated lower urinary tract symptoms（ LUTS）,and to evaluate the reliability and efficacy of animal experiment.Methods Database including PubMed,Embase,Elsevier,CNKI and Google Scholar were searched within a time period of 2007 to October2013 for collecting the literature about ketamine associated LUTS and animal experiments,and the references of those RCTs were also searched.After study selection,assessment and data extraction conducted by two reviewers independently,system review was perform by method of qualitative analysis.The level of evidence was assessed by using STAIR and CAMARADES lists.Results Twelve cases reports all covered ketamine associated LUTS,the main clinical manifestations were urinary frequency,urgency,suprapubic pain.Three animal experiments were included.Due to the poor the methodological quality of animal experiments and the small number of included studies,the system evaluation was not suitable for meta-analysis.There are some limited evidence showing that ketamine could cause murine bladder wall thickening（ P〈0.01）.Conclusion The system evaluation indicates no convincing evidence to prove the reliability of animal experiments in the study of ketamine associated LUTS.