艾司氯胺酮对不同人格类型剖宫产患者产后抑郁的影响：随机对照试验

Effects of Esketamine on Post-Partum Depression in Patients With Different Personality Types Undergoing Caesarean Section: Randomised Controlled Trial.

作者信息

Luo Mei, Tang Ni, Guo Yang, Fan Di, Wang Xiaobin

机构信息

Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan, China.

出版信息

Actas Esp Psiquiatr. 2025 Aug;53(4):766-777. doi: 10.62641/aep.v53i4.1965.

DOI:10.62641/aep.v53i4.1965

PMID:40791037

Abstract

BACKGROUND

As an intravenous general anaesthetic, esketamine has rapid and evident antidepressant effects and therefore helps prevent post-partum depression (PPD). This study aimed to observe the effect of intraoperative esketamine application on patients with PPD undergoing caesarean section and to explore whether this effect varies among patients with different personality types.

METHODS

A total of 280 patients who underwent elective caesarean section under spinal anaesthesia were randomly divided into esketamine and control groups. On the day before the surgery, each patient was assessed using the Edinburgh Post-partum Depression Scale (EPDS), Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale (SDS) and Eysenck Personality Questionnaire. Additionally, the pressure-pain threshold was measured. The esketamine group received a single intravenous injection of esketamine at a dose of 0.25 mg/kg (diluted to 5 mL and administered intravenously within 10 min after foetus removal). The control group received 5 mL of 0.9% normal saline. The primary outcome was PPD incidence, assessed using the EPDS on the 3rd post-operative day. The secondary outcomes included post-operative pain score and esketamine safety assessment.

RESULTS

Statistically significant differences in PPD incidence were observed among patients with different personality types (introverted unstable, 66.70%; extroverted unstable, 45.50%; extroverted stable, 19.40%; and introverted stable, 15.00%, p < 0.05). The patients with an extroverted-stable personality in the esketamine group had a lower PPD incidence than those in the control group (11.90% vs. 25.70%, p < 0.05). No statistical difference in total PPD incidence was observed between the two groups (35.7% vs. 29.3%, p > 0.05). Pain scores in the esketamine group were lower than those in the control group while at rest (4, 24 and 48 h) and during movement (4 and 8 h) after surgery (p < 0.05). The mean arterial pressure and heart rate in the esketamine group were higher than those in the control group during surgery (p < 0.05).

CONCLUSION

A single intravenous administration of esketamine had no apparent effect on the overall PPD incidence among patients undergoing caesarean section. It may have a beneficial effect in reducing PPD incidence in patients with an extroverted-stable personality.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2100050976, 09/09/2021, http://www.chictr.org.cn.

摘要

背景

作为一种静脉全身麻醉剂，艾司氯胺酮具有快速且明显的抗抑郁作用，因此有助于预防产后抑郁症（PPD）。本研究旨在观察术中应用艾司氯胺酮对行剖宫产术的PPD患者的影响，并探讨这种影响在不同性格类型的患者中是否存在差异。

方法

总共280例行腰麻下择期剖宫产术的患者被随机分为艾司氯胺酮组和对照组。在手术前一天，使用爱丁堡产后抑郁量表（EPDS）、自评焦虑量表（SAS）、自评抑郁量表（SDS）和艾森克人格问卷对每位患者进行评估。此外，测量压力痛阈。艾司氯胺酮组在胎儿娩出后10分钟内静脉注射一剂0.25mg/kg的艾司氯胺酮（稀释至5mL）。对照组接受5mL的0.9%生理盐水。主要结局是PPD发生率，在术后第3天使用EPDS进行评估。次要结局包括术后疼痛评分和艾司氯胺酮安全性评估。

结果

不同性格类型的患者在PPD发生率上存在统计学显著差异（内向不稳定型，66.70%；外向不稳定型，45.50%；外向稳定型，19.40%；内向稳定型，15.00%，p<0.05）。艾司氯胺酮组中性格外向稳定的患者PPD发生率低于对照组（11.90%对25.70%，p<0.05）。两组之间的总体PPD发生率没有统计学差异（35.7%对29.3%，p>0.05）。艾司氯胺酮组在术后静息时（4、24和48小时）以及活动时（4和8小时）的疼痛评分低于对照组（p<0.05）。艾司氯胺酮组在手术期间的平均动脉压和心率高于对照组（p<0.05）。