Effects Of Different Doses Of Esketamine On Postpartum Mood Of Parturient With Depressive Tendency

Objective:To evaluate the effect of intravenous injection of different doses of esketamine on postpartum mood in women with depressive tendency during cesarean section.To explore the effective dose of esketamine to prevent postpartum depression.To observe the effect of different doses of esketamine on postoperative analgesia.Methods:This study was a randomized controlled trial.90 patients who planned to undergo caesarean section operation under spinal anesthesia in our hospital were selected and randomly divided into 3 groups by Excel classification method.All included patients were American Society of Anesthesiologists（ASA）gradeⅡand Edinburgh Postpartum Depression Scale（EPDS）score 9-13.After delivery,group D was given intravenous normal saline,group L was given intravenous 0.25mg/kg esketamine,and group H was given intravenous0.5mg/kg esketamine.EPDS scores were recorded 1 day before surgery,1 day after surgery and 2 days after surgery.Maternal cortisol concentration were recorded 1 day before surgery and 1 day after surgery.Heart rate（HR）,mean arterial pressure（MAP）,pulse oxygen saturation（Sp O₂）,respiratory rate（RR）,Ramsay and adverse reactions were recorded at the time of entry（T₁）,5min before administration（T₂）,immediately after administration（T₃）,5min after administration（T₄）,10min after administration（T₅）,and 30min after administration（T₆）.The VAS scores,the number of analgesic pump compressions,relief analgesia and postoperative adverse reactions were recorded at 3h,6h,12h,24h and 48h after the operation.Results:1.Comparison of maternal general conditions.There were no significant differences in age,gestational age,parity,height,weight,BMI,social background of education,employment,unintended pregnancy,adverse pregnancy history,family income,family relationship,residence,operation time,anesthesia time,exhaust time,getting out of bed time and vaginal bleeding among the three groups（P>0.05）.2.Comparison of EPDS scoresCompared with group D and group L,1d and 2d after surgery EPDS scores of group H were significantly decreased（P<0.05）.3.Comparison of maternal cortisol concentrationThere was no significant difference in preoperative cortisol concentration among the three groups（P>0.05）.1d after surgery group H was lower than group D and group L（P<0.05）.4.Comparison of intraoperative vital signsCompared with group D,HR of group L and group H had a transient increase at T₃and T₄（P<0.05）,while HR of group L and group H had no significant difference at T₃and T₄（P>0.05）.There was no significant difference in MAP,Sp O2 and RR at each time point among the three groups（P>0.05）.Compared with group D,Ramsay score of group L and group H increased at each time point after administration（P<0.05）,and at T₃,T₄ and T₅,group H was higher than group L（P<0.05）.5.Comparison of postoperative analgesiaAt 3h,6h,12h,24h and 48h after the operation,there was no statistical significance in VAS scores between group D and group L（P>0.05）,but compared with groups D and L,VAS scores in group H were significantly decreased（P<0.05）.The number of analgesic pump pressing in group L and group H was significantly lower than that in group D at each time point（P<0.05）,and the number of additional analgesic pump in 12h、24h、48h,group H was significantly lower than that in group L（P<0.05）.6.Adverse reactionsThe incidence of dreams in group H was higher than that in the other two groups（P<0.05）,and the number of relief analgesics was lower than that in the other two groups（P<0.05）.There was no significant difference in other adverse reactions（nausea and vomiting,vertigo,pruritus,hypertension,hypotension,tachycardia,bradycardia,hypoxemia and chills）after intraoperative medication（P>0.05）.There was no significant difference in postoperative adverse reactions（nausea,vomiting,pruritus,vertigo）（P>0.05）.Conclusions:The application of 0.5mg/kg esketamine in cesarean section can improve the short-term postpartum mood.