剖宫产术前应用 Esketamine 可降低产后抑郁症发生率：一项随机对照试验。
Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail.
机构信息
Department of Anesthesiology, Nanjing Medical University, Nanjing, 210000, Jiangsu, China.
Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, Jiangsu, China.
出版信息
BMC Anesthesiol. 2024 Jan 10;24(1):20. doi: 10.1186/s12871-023-02398-1.
BACKGROUND
Postpartum depression (PPD) is a common mental disease in postpartum women, which has received more and more attention in society. Ketamine has been confirmed for its rapid antidepressant effect in women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence of PPD.
METHODS
All the parturients enrolled in the study were randomly assigned to two groups: the esktamine group (0.2 mg/kg esketamine) and the control group (a same volume of saline). All the drugs were pumped for 40 min started from the beginning of the surgery. The Amsterdam Anxiety and Information Scale (APAIS) scores before the surgery, the Edinburgh postnatal depression scale (EPDS) scores at 4 d and 42 d after surgery, the Pain Numerical Rating Scale (NRS) scores at 6 h, 12 h, 24 h and 48 h post-operation were evaluated, as well as the adverse reactions were recorded.
RESULTS
A total of 319 parturients were analyzed in the study. The incidence of PPD (EPDS score > 9) in the esketamine group was lower than the control group at 4 days after surgery (13.8% vs 23.1%, P = 0.0430) but not 42 days after surgery (P = 0.0987). Esketamine 0.2 mg/kg could reduce the NRS score at 6 h,12 h and 24 h after surgery, as well as the use of vasoactive drugs during surgery (P < 0.05). The incidences of maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) and drowsiness (3.8%) in the esketamine group were higher than those of control group (P < 0.05).
CONCLUSIONS
Intraoperative injection of esketamine (0.2 mg/kg) prevented the occurrence of depression (EPDS score > 9) at 4 days after delivery but not 42 days. Esketamine reduced the NRS scores at 6 h, 12 h and 24 h after surgery, but the occurrence of maternal side effects such as dizziness, blurred vision, drowsiness and hallucination were increased.
TRIAL REGISTRATION
Registered in the Chinese Clinical Trial Registry (ChiCTR2100053422) on 20/11/2021.
背景
产后抑郁症（PPD）是产后女性常见的精神疾病，已受到社会越来越多的关注。氯胺酮已被证实对 PPD 女性具有快速抗抑郁作用。我们推测剖宫产术前使用氯胺酮的对映异构体右美沙芬也可以降低 PPD 的发生率。
方法
所有入组的产妇均随机分为两组：右美沙芬组（0.2mg/kg 右美沙芬）和对照组（相同体积的生理盐水）。所有药物均从手术开始时开始输注 40min。评估术前阿姆斯特丹焦虑和信息量表（APAIS）评分、术后 4d 和 42d 的爱丁堡产后抑郁量表（EPDS）评分、术后 6h、12h、24h 和 48h 的疼痛数字评分量表（NRS）评分，并记录不良反应。
结果
本研究共分析了 319 名产妇。与对照组相比，右美沙芬组在术后 4 天（13.8% vs 23.1%，P=0.0430）而非术后 42 天（P=0.0987）的 PPD（EPDS 评分>9）发生率较低。0.2mg/kg 右美沙芬可降低术后 6h、12h 和 24h 的 NRS 评分，以及术中血管活性药物的使用（P<0.05）。右美沙芬组产妇头晕（17.0%）、视物模糊（5%）、幻觉（3.8%）和嗜睡（3.8%）的发生率高于对照组（P<0.05）。
结论
剖宫产术中注射右美沙芬（0.2mg/kg）可预防产后 4 天发生抑郁（EPDS 评分>9），但不能预防产后 42 天发生抑郁。右美沙芬降低了术后 6h、12h 和 24h 的 NRS 评分，但增加了头晕、视物模糊、嗜睡和幻觉等母体不良反应的发生。
试验注册
于 2021 年 11 月 20 日在中国临床试验注册中心（ChiCTR2100053422）注册。
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