Li Shuying, Zhou Wenqin, Li Ping, Lin Rongqian
Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
Department of Anesthesiology, West China Second Hospital of Sichuan University, Key laboratory of Birth Deficits and related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
J Affect Disord. 2024 Apr 15;351:720-728. doi: 10.1016/j.jad.2024.01.202. Epub 2024 Jan 28.
Ketamine and esketamine has been suggested to have potential efficacy in preventing postpartum depression (PPD) recent years. The aim of this meta-analysis was to evaluate the effectiveness of ketamine and esketamine on PPD after cesarean delivery.
We systematically searched PubMed, Embase, and the Cochrane Library for studies investigating the efficacy of ketamine and esketamine in preventing PPD. The primary outcomes of this study were risk ratios (RRs) and EPDS scores (Edinburgh Postnatal Depression Scale) in relation to PPD after ketamine and esketamine. The second outcomes were the postoperative adverse events.
Thirteen randomized controlled trials (RCTs) and one retrospective study including 2916 patients were analyzed, including six on the use of ketamine and eight on the use of esketamine. The risk ratios and EPDS scores of PPD were significantly decreased in the ketamine/esketamine group compared to those in the control group in one week and four weeks postoperative periods. Subgroup analyses showed that high dosage, administrated in patient controlled intravenous analgesia (PCIA) method and only esketamine exhibited a significant reduction in the incidence and EPDS scores of PPD in one week and four week postoperative. However, the incidences of postoperative adverse events, such as dizziness, diplopia, hallucination, and headache were significantly higher in the ketamine/esketamine group than that in the control group.
Ketamine and esketamine appear to be effective in preventing PPD in the one week and four week postoperative periods after cesarean delivery with moderate certainty of evidence. But they can also lead to some short-term complications too. Future high-quality studies are needed to confirm the efficacy of ketamine and esketamine in different countries.
近年来，已有研究表明氯胺酮和艾司氯胺酮在预防产后抑郁症（PPD）方面具有潜在疗效。本荟萃分析的目的是评估氯胺酮和艾司氯胺酮对剖宫产术后PPD的有效性。
我们系统检索了PubMed、Embase和Cochrane图书馆，以查找研究氯胺酮和艾司氯胺酮预防PPD疗效的研究。本研究的主要结局是与氯胺酮和艾司氯胺酮后PPD相关的风险比（RRs）和爱丁堡产后抑郁量表（EPDS）评分。次要结局是术后不良事件。
分析了13项随机对照试验（RCT）和1项回顾性研究，共2916例患者，其中6项使用氯胺酮，8项使用艾司氯胺酮。与对照组相比，氯胺酮/艾司氯胺酮组在术后1周和4周时PPD的风险比和EPDS评分显著降低。亚组分析显示，高剂量、采用患者自控静脉镇痛（PCIA）方法给药且仅使用艾司氯胺酮在术后1周和4周时PPD的发生率和EPDS评分显著降低。然而，氯胺酮/艾司氯胺酮组术后不良事件如头晕、复视、幻觉和头痛的发生率显著高于对照组。
氯胺酮和艾司氯胺酮在剖宫产术后1周和4周预防PPD方面似乎有效，证据具有中等确定性。但它们也会导致一些短期并发症。未来需要高质量的研究来证实氯胺酮和艾司氯胺酮在不同国家的疗效。
