Abstract：
OBJECTIVE: Status epilepticus (SE) is a common neurological medical emergency in the pediatric population, with 10%-40% of cases progressing to refractory SE (RSE), requiring treatment with anesthetic infusions. We present a systematic review and meta-analysis of the use of ketamine for the treatment of pediatric SE and its potential advantages over other anesthetic infusions.
METHODS: This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Electronic databases, including PubMed, Cochrane Library, Ovid, Embase, and Google Scholar, were searched with the keywords \"pediatrics,\" \"status epilepticus,\" and \"ketamine treatment.\" Randomized trials, prospective and retrospective cohort studies, and case reports were considered for inclusion.
RESULTS: Eighteen publications met the initial inclusion criteria. The 18 publications comprise 11 case reports, one nonconclusive clinical trial, two case series, and four retrospective cohorts. After excluding the case reports because of reporting bias, only the six case series and cohorts were included in the final analysis. There were 172 patients in the six included studies. The weighted age was 9.93 (SD = 10.29) years. The weighted maximum dose was 7.44 (SD = 9.39) mg/kg/h. SE cessation was attained in 51% (95% confidence interval = 43-59) of cases with the addition of ketamine. The heterogeneity was I2 = 0%, t2 = 0, χ2 (5) = 3.39 (p = .64).
CONCLUSIONS: Pediatric RSE is difficult to treat, resulting in increased morbidity and mortality. Without strong recommendations and evidence regarding preferred agents, this review provides evidence that ketamine may be considered in managing SE in the pediatric population.
METHODS: This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Electronic databases, including PubMed, Cochrane Library, Ovid, Embase, and Google Scholar, were searched with the keywords \"pediatrics,\" \"status epilepticus,\" and \"ketamine treatment.\" Randomized trials, prospective and retrospective cohort studies, and case reports were considered for inclusion.
RESULTS: Eighteen publications met the initial inclusion criteria. The 18 publications comprise 11 case reports, one nonconclusive clinical trial, two case series, and four retrospective cohorts. After excluding the case reports because of reporting bias, only the six case series and cohorts were included in the final analysis. There were 172 patients in the six included studies. The weighted age was 9.93 (SD = 10.29) years. The weighted maximum dose was 7.44 (SD = 9.39) mg/kg/h. SE cessation was attained in 51% (95% confidence interval = 43-59) of cases with the addition of ketamine. The heterogeneity was I2 = 0%, t2 = 0, χ2 (5) = 3.39 (p = .64).
CONCLUSIONS: Pediatric RSE is difficult to treat, resulting in increased morbidity and mortality. Without strong recommendations and evidence regarding preferred agents, this review provides evidence that ketamine may be considered in managing SE in the pediatric population.
摘要：
目的：癫痫持续状态（SE）是儿科人群中常见的神经系统医学急症，10%-40%的病例进展为难治性SE(RSE)，需要用麻醉输液治疗.我们对氯胺酮用于治疗小儿SE及其相对于其他麻醉剂输注的潜在优势进行了系统评价和荟萃分析。
方法：本综述遵循PRISMA（系统评价和荟萃分析的首选报告项目）声明。电子数据库,包括PubMed,科克伦图书馆,奥维德,Embase,和谷歌学者，用关键词“儿科”搜索，“\”癫痫持续状态，“和”氯胺酮治疗。“随机试验，前瞻性和回顾性队列研究，并考虑纳入病例报告.
结果：18篇出版物符合初始纳入标准。这18份出版物包括11份病例报告，一项非决定性的临床试验，两个案例系列，和四个回顾性队列。由于报告偏倚而排除病例报告后，只有6个病例系列和队列被纳入最终分析.在纳入的6项研究中有172名患者。加权年龄为9.93(SD=10.29)岁。加权最大剂量为7.44(SD=9.39)mg/kg/h。添加氯胺酮的病例中有51％（95％置信区间=43-59）达到SE停止。异质性为I2=0%，t2=0,χ2(5)=3.39(p=.64)。
结论：小儿RSE难以治疗，导致发病率和死亡率增加。如果没有关于首选代理人的强有力的建议和证据，本综述提供了氯胺酮可用于治疗儿科人群SE的证据.
方法：本综述遵循PRISMA（系统评价和荟萃分析的首选报告项目）声明。电子数据库,包括PubMed,科克伦图书馆,奥维德,Embase,和谷歌学者，用关键词“儿科”搜索，“\”癫痫持续状态，“和”氯胺酮治疗。“随机试验，前瞻性和回顾性队列研究，并考虑纳入病例报告.
结果：18篇出版物符合初始纳入标准。这18份出版物包括11份病例报告，一项非决定性的临床试验，两个案例系列，和四个回顾性队列。由于报告偏倚而排除病例报告后，只有6个病例系列和队列被纳入最终分析.在纳入的6项研究中有172名患者。加权年龄为9.93(SD=10.29)岁。加权最大剂量为7.44(SD=9.39)mg/kg/h。添加氯胺酮的病例中有51％（95％置信区间=43-59）达到SE停止。异质性为I2=0%，t2=0,χ2(5)=3.39(p=.64)。
结论：小儿RSE难以治疗，导致发病率和死亡率增加。如果没有关于首选代理人的强有力的建议和证据，本综述提供了氯胺酮可用于治疗儿科人群SE的证据.
