单次静脉注射氯胺酮对分娩镇痛后产后抑郁的影响及潜在机制：一项随机、双盲对照试验。
Effect of single intravenous injection of esketamine on postpartum depression after labor analgesia and potential mechanisms: a randomized, double-blinded controlled trial.
机构信息
Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, CN-Jiangsu, No. 169 Hushan Road, Nanjing, 211100, China.
Department of Anesthesiology, Nanjing Jiangning Hospital of Traditional Chinese Medicine, Nangjing, 211100, China.
出版信息
BMC Pharmacol Toxicol. 2023 Nov 23;24(1):66. doi: 10.1186/s40360-023-00705-7.
BACKGROUND
The study was designed to investigate effects of single intravenous injection of esketamine on the incidence of postpartum depression (PPD) after labor analgesia and explore the potential mechanisms.
METHODS
A total of 120 women who underwent labor analgesia by epidural analgesia pump were enrolled and divided into two groups randomly. Esketamine at a dose of 0.2 mg/kg was intravenously injected after fetal disengagement in the test group and placebo was administered in the control group. The occurrence of PPD and side effects after delivery were recorded. Some indicators related to stress and inflammation were measured before labor analgesia and at 24 h, 1 week, and 6 weeks after delivery in this study. Data were analyzed by independent t-test, repeated measures analysis of variance and Chi-square test in SPSS software (version 25.0). It was considered statistically significant since a p value less than 0.05.
RESULTS
The incidence of PPD was significantly decreased both for one week and six weeks after delivery by using of esketamine (3.4% vs. 15.3%, p = 0.004 and 5.2% vs. 18.6%, p = 0.006, respectively). There were also significant differences between the stress and inflammation-related indicators in different time points in this study, while the side effects for 48 h after delivery were similar between the two groups.
CONCLUSIONS
Single intravenous injection of esketamine after delivery in participants underwent labor analgesia can decrease the occurrence of postpartum depression for one week and six weeks after delivery, while the side effects were not increased. The antidepressant effects of esketamine may be related to the reduction of stress response and inflammation.
TRIAL REGISTRATION
The trial was registered at the Chinese Clinical Trial Registry on 5/30/2022 (CTRI registration number-ChiCTR2200060387). URL of registry: https://www.chictr.org.cn/bin/home .
背景
本研究旨在探讨单次静脉注射氯胺酮对分娩镇痛后产后抑郁（PPD）发生率的影响，并探讨其潜在机制。
方法
本研究共纳入 120 例行硬膜外镇痛泵分娩镇痛的产妇，随机分为两组。实验组胎儿娩出后静脉注射氯胺酮 0.2mg/kg，对照组给予安慰剂。记录产后 PPD 的发生情况及不良反应。本研究于分娩镇痛前、分娩后 24h、1 周和 6 周分别测量与应激和炎症相关的一些指标。采用 SPSS 软件（版本 25.0）进行独立 t 检验、重复测量方差分析和卡方检验。p 值<0.05 为差异有统计学意义。
结果
使用氯胺酮可显著降低产后 1 周和 6 周的 PPD 发生率（3.4%比 15.3%，p=0.004 和 5.2%比 18.6%，p=0.006）。不同时间点的应激和炎症相关指标也存在显著差异，而两组产后 48h 的不良反应相似。
结论
分娩镇痛后单次静脉注射氯胺酮可降低产后 1 周和 6 周 PPD 的发生率，且不增加不良反应。氯胺酮的抗抑郁作用可能与减轻应激反应和炎症有关。
试验注册
本试验于 2022 年 5 月 30 日在中国临床试验注册中心注册（注册号：ChiCTR2200060387）。网址：https://www.chictr.org.cn/bin/home。
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