Effects Of Different Doses Of Esketamine Intervention On Postpartum Depressive Symptoms In Cesarean Section Women

Objective: To investigate the effect of different doses of esketamine on postpartum depressive symptoms(PDS)in cesarean section women with prenatal depression.Methods: This study is a two-center,randomized,double-blind controlled trial.300 cesarean section women who met the inclusion criteria(EPDS score > 9 points)were randomly divided into three groups.Both the low-dose and the high-dose esketamine group received a infusion with 0.25 mg/kg esketamine,while the control group received a infusion with 0.9% saline.All women received postoperative analgesia pump(PCIA)immediately after completing the 10-min infusion(Highdose group: sufentanil 2.2ug/kg + esketamine 2.0mg/kg;Low-dose group:sufentanil 2.2ug/kg + esketamine 1.0mg/kg;Control group: sufentanil2.2ug/kg).The incidence of PDS were assessed by the Edinburgh Postpartum Depression Scale(EPDS).Maternal postoperative analgesia(NRS score),sedation(Ramsay sedation score)and sleep quality score(ISI score)were also assessed.Results: 1.0.25mg/kg of esketamine ivvp.combined with 1mg/kg esketamine PCIA can reduce the incidence of PDS at 7 days postpartum(29.9% vs 11.1%,P<0.05).2.0.25mg/kg of esketamine ivvp.combined with 2mg/kg esketamine PCIA can reduce the incidence of PDS at 7 and42 days postpartum(29.9% vs.7.1%,P<0.05;27.8% vs 9.1%,P<0.05).3.PCIA combined with 1mg/kg or 2mg/kg of esketamine could effectively reduce the NRS scores at rest within 48 h postoperatively(P<0.05),but the 2mg/kg group could reduce the NRS score during movement at 48 h postoperatively(P<0.05).4.1mg/kg and 2mg/kg esketamine PCIA did not increase postoperative adverse reactions(P>0.05).Conclusions: 1.0.25mg/kg of esketamine ivvp.combined with1mg/kg esketamine PCIA can reduce the incidence of PDS at 7 days postpartum.2.0.25mg/kg of esketamine ivvp.combined with 2mg/kg esketamine PCIA can reduce the incidence of PDS at 7 and 42 days postpartum.3.Esketamine can effectively relieve the rest pain after cesarean section,but PCIA combined with 2 mg/kg of esketamine seems better during movement.4.1mg/kg and 2mg/kg esketamine PCIA did not increase postoperative adverse reactions(P>0.05).