Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu 210004, China.
Department of Emergency, The Second Hospital of Nanjing, Jiangsu 210003, China.
J Affect Disord. 2023 May 15;329:525-530. doi: 10.1016/j.jad.2023.02.127. Epub 2023 Feb 28.
Patients with missed miscarriages are usually accompanied by varying degrees of depression, which is closely related to the patient's prognosis. We investigated whether Esketamine could alleviate postoperative depression symptoms in patients with missed miscarriages who underwent painless curettage.
This study was a randomized, parallel-controlled, double-blind, single-center trial. A total of 105 patients with preoperative 1d (EPDS) ≥ 10 were randomly assigned to the Propofol; Dezocine; Esketamine group. Patients record EPDS at 7 and 42 days after the operation. Secondary outcomes included VAS for 1 h postoperation, total propofol usage, adverse reactions, And the expressions of inflammatory factors of TNF-α, IL-1β, IL-6, IL-8, and IL-10.
Compared with the P and D group, patients in the S group had lower EPDS scores at 7 day (8.63 ± 3.14, 9.17 ± 3.23 vs. 6.34 ± 2.87 P = 0.0005) and 42 days (9.40 ± 2.67, 8.49 ± 3.05 vs.5.31 ± 2.49 P < 0.0001) after the operation. Respectively, Compared with the P group, the VAS scores (3.51 ± 1.12 vs. 2.80 ± 0.83, 2.40 ± 0.81, P = 0.0035) and the dosage of propofol used during operation (198.7 ± 47.48 vs. 145.5 ± 19.31, 142.9 ± 21.01 P < 0.0001) were lower in the D and S groups, and lower postoperative inflammatory response at 1 day after surgery. Other outcomes among the three groups were not found to the difference.
Esketamine effectively treated postoperative depressive symptoms of patients with a missed miscarriage, decreasing propofol consumption and inflammatory response.
稽留流产患者常伴有不同程度的抑郁，与患者预后密切相关。本研究旨在探讨依托咪酯、地佐辛和氯胺酮复合丙泊酚用于无痛清宫术对稽留流产患者术后抑郁的影响。
本研究为随机、平行对照、双盲、单中心临床试验。选择术前 EPDS（抑郁自评量表）评分≥10 分的稽留流产患者 105 例，随机分为依托咪酯组、地佐辛组和氯胺酮组。术后 7、42 天记录 EPDS 评分，记录术后 1 h 内 VAS 评分、丙泊酚总用量、不良反应，以及 TNF-α、IL-1β、IL-6、IL-8、IL-10 等炎症因子的表达。
与 P、D 组相比，S 组术后 7 天（8.63±3.14、9.17±3.23 比 6.34±2.87，P=0.0005）和 42 天（9.40±2.67、8.49±3.05 比 5.31±2.49，P<0.0001）时 EPDS 评分较低。与 P 组相比，D、S 组术后 1 h 时 VAS 评分（3.51±1.12 比 2.80±0.83、2.40±0.81，P=0.0035）和丙泊酚用量（198.7±47.48 比 145.5±19.31、142.9±21.01，P<0.0001）较低，术后 1 d 炎症反应较轻。三组其他结果差异无统计学意义。
氯胺酮复合丙泊酚可有效治疗稽留流产患者清宫术后抑郁症状，减少丙泊酚用量，减轻术后炎症反应。
