Xu Yang, Li Yuantao, Huang Xiaolei, Chen Daili, She Baozuan, Ma Daqing
Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, 2004 Honglilu Road, Futian District, Shenzhen, China.
Section of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Chelsea & Westminster Hospital, Imperial College London, 369 Fulham Road, London, UK.
Arch Gynecol Obstet. 2017 May;295(5):1167-1174. doi: 10.1007/s00404-017-4334-8. Epub 2017 Mar 29.
Postpartum depression is a common complication of childbirth. In the last decade, it has been suggested that subdissociative-dose ketamine is a fast-acting antidepressant. We aimed to investigate the efficacy of low-dose ketamine administered during caesarean section in preventing postpartum depression.
Using a randomized, double-blind, placebo-controlled design, 330 parturients who were scheduled to undergo caesarean section were enrolled in this trial. The parturients were randomly assigned to receive intravenous ketamine (0.25 mg/kg diluted to 10 mL with 0.9% saline) or placebo (10 mL of 0.9% saline) within 5 min following clamping of the neonatal umbilical cord. The primary outcome was the degree of depression, which was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) (a threshold of 9/10 was used) at 3 days and 6 weeks after delivery. The secondary outcome was the numeric rating scale score of pain at 3 day and 6 week postpartum.
No significant differences were found in the prevalence of postpartum depression between the two groups at 3 days and 6 weeks after delivery. The pain scores measured at 3 days postoperatively were not significantly different between the groups, whereas the scores measured at 6 week postpartum were significantly reduced in the treatment group compared with the saline group (P = 0.014).
Intra-operative low-dose ketamine (0.25 mg/kg) does not have a preventive effect on postpartum depression.
产后抑郁是分娩常见的并发症。在过去十年中，有研究表明亚解离剂量的氯胺酮是一种起效迅速的抗抑郁药。我们旨在研究剖宫产术中给予低剂量氯胺酮预防产后抑郁的疗效。
采用随机、双盲、安慰剂对照设计，330例计划行剖宫产的产妇纳入本试验。产妇在新生儿脐带结扎后5分钟内随机接受静脉注射氯胺酮（0.25mg/kg用0.9%生理盐水稀释至10mL）或安慰剂（10mL 0.9%生理盐水）。主要结局指标为抑郁程度，在产后3天和6周时采用爱丁堡产后抑郁量表（EPDS）进行评估（采用9/10的阈值）。次要结局指标为产后3天和6周时的疼痛数字评分量表得分。
两组在产后3天和6周时产后抑郁的发生率无显著差异。术后3天两组的疼痛评分无显著差异，而产后6周时治疗组的评分与生理盐水组相比显著降低（P = 0.014）。
术中低剂量氯胺酮（0.25mg/kg）对产后抑郁无预防作用。
