| Objective: To observe the efficacy of perioperative administration of low-dose esketamine overdose intervention and postoperative intravenous self-administered analgesia(PCIA)on postoperative analgesia,stress response and postpartum depression in women undergoing cesarean section,and to investigate the effects on plasma brain-derived neurotrophic factor(BDNF)and inflammatory factor interleukin-6(IL-6)and their correlation in postpartum depression.Methods: Two hundred and eighty women who underwent cesarean section and were randomly divided into 140 cases in the esketamine(ASL)group and 140 cases in the control(DZ)group.5 ml of 0.35 mg/kg esketamine solution prepared with 0.9% sodium chloride injection was used in the ASL group 1 minute before skin incision and 0.9% sodium chloride injection was used for postoperative analgesia.Esketamine 0.9mg/kg + Butorphanol0.24mg/kg + Ondansetron 8mg,prepared in a total volume of 120 ml.in the DZ group,5ml of saline with placebo was used 1 minute before skin incision,and0.9% sodium chloride injection prepared with sufentanil 1.2ug/kg +Butorphanol 0.24mg/kg + Ondansetron 8mg was used for postoperative analgesia,prepared in a total volume of 120 ml.The following data were collected from two groups:1.Maternal height,weight,body mass index,age,number of pregnancies,number of births,american society of anesthesiologists(ASA)classification,pregnancy weight gain values and vital signs at admission were recorded before surgery in the enrolled group.2.Maternal vital signs at admission(t0),at rest on the operating bed(t1),at skin incision(t2),at5 min of drug administration(t3)and at discharge from the postanesthesia care unit(PACU)(t4);sedation(Ramsay)scores at discharge from the operating room;rest,contraction and motor(cough)pain visual analogue scale(VAS)scores at 4h,12 h,24h and 48 h postoperatively;admission,postoperative 7d,1m and 3m postoperative anxiety self-assessment scale(SAS)scores;7d,1m and 3m postoperative edinburgh postpartum depression scale(EPDS)scores.3.Apgar score,number of assisted ventilation cases,number of transfers to neonatal intensive care unit(ICU)and postoperative jaundice values at 72 h after fetal delivery.4.Patients’ operation time,bleeding volume,fetal delivery time and the number of intraoperative vasoactive drugs used.5.The percentage of neutrophils and white blood cell count in maternal blood of both groups before and 48 h after surgery,and the levels of BDNF and cellular inflammatory factor IL-6 in plasma of both groups were measured by enzyme-linked immunosorbent assay(ELISA)before and 48 h after surgery.6.The women were returned for 1m and 3m postoperative low back pain and willingness to give birth again after surgery.7.The incidence of complications related to maternal perioperative nausea and vomiting,chills,and neurological symptoms(hallucinogenic,nightmares,dizziness)was recorded.Results:1.Comparison of general data: there was no statistically significant difference between the two groups on items of maternal height,weight,body mass index,age,ASA classification,pregnancy weight gain value,and preoperative SAS score(P>0.05).2.Comparison of maternal vital signs between the two groups during the perioperative period: there was no statistically significant difference between the two groups in terms of heart rate,blood pressure and oxygen saturation at the time of admission,at the time of admission to the operating room and at the time of discharge from the operating room(P>0.05),but the heart rate and blood pressure were higher in the ASL group than in the DZ group at the time of skin incision and 5 min after drug administration,and there was a statistically significant difference between the two groups(P<0.05).3.Comparison of the effects on the fetus: There was no statistically significant difference in the apgar score and the proportion of fetuses requiring assisted ventilation after delivery and the proportion of postoperative transfers to the neonatal ICU between the two groups(P>0.05).4.Comparison of patients’ recovery: the maternal bleeding,operation time,delivery time and number of vasoactive drugs required in the ASL group were less than those in the DZ group,and the statistical difference between the two groups was significant(P<0.05).The incidence of perioperative vomiting and chills was lower in the ASL group than in the DZ group,and the statistical difference between the two groups was significant(P<0.05).The incidence of perioperative neurological symptoms(hallucinations,nightmares,delirium)was higher in the ASL group than in the DZ group,and the statistical difference between the two groups was significant(P<0.05).There was no statistically significant difference in the postoperative 1m and 3m low back pain score scores between the two groups(P>0.05).5.perioperative SAS scores and incidence of anxiety and depression: there was no statistically significant difference between the two groups in preoperative SAS scores(P>0.05),but the maternal SAS scores at 7d and 1m postoperatively in the ASL group were lower than those in the DZ group,and the incidence of anxiety was lower than that in the DZ group,and the statistical difference between the two groups was significant(P<0.05).The maternal SAS scores and the incidence of anxiety were not statistically significant between the two groups at 3m postoperatively(P>0.05).7d and 1m postoperatively,the maternal EPDS scores in the ASL group were lower than those in the DZ group,and the incidence of depression was lower than that in the DZ group,with statistically significant differences between the two groups(P<0.05).There was no statistically significant difference in the EPDS scores and the incidence of depression between the two groups at 3m postoperatively(P>0.05).6.Maternal VAS pain scores at rest,contraction and exercise and sedation(Ramsay)scores at discharge from the PACU: The maternal VAS pain scores at rest,contraction and exercise(cough)were lower in the ASL group than in the DZ group at 4h,12 h,24h and 48 h after surgery,with statistically significant differences between the two groups(P<0.05).There was no statistically significant difference in sedation(Ramsay)scores at the time of exit from the operating room between the two groups(P>0.05).7.Comparison of maternal routine blood results between the two groups: The postoperative neutrophil percentage and leukocyte count were higher in the DZ group than in the ASL group,with a statistically significant difference between the two groups(P<0.05).8.Comparison of BDNF and IL-6in plasma: The plasma BDNF levels were higher in the ASL group than in the DZ group,and the plasma of IL-6 levels were lower in the ASL group than in the DZ group,at the same time the statistical difference between the two groups was significant(P<0.05).Conclusion: 1.The use of esketamine in the perioperative period can effectively reduce the incidence of 1m postpartum anxiety and depression in women undergoing cesarean section,while there was no significant difference in the incidence of 3m anxiety and depression.2.The use of esketamine in the perioperative period provided good postoperative analgesia,better maintained stable peripartum circulation,reduced the incidence of peripartum nausea and vomiting and chills,and accelerated postoperative recovery without affecting the fetal Apgar score.3.The use of esketamine in the perioperative period reduces maternal neutrophil percentage and leukocyte release,decreases maternal plasma IL-6 secretion,attenuates the inflammatory response,and enhances BDNF secretion,promoting recovery from postpartum depression. |
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