艾司氯胺酮用于硬膜外分娩镇痛对产后抑郁症发生的影响

Effect of esmketamine for labor analgesia on development of postpartum depression

目的评价艾司氯胺酮用于硬膜外分娩镇痛对产后抑郁症(PPD)发生的影响。方法选择自然分娩且同意实施分娩镇痛的初次孕产妇242例, 采用分层随机法分为2组:常规组(C-LA组, n=119)和艾司氯胺酮配伍组(E-LA组, n=123)。C-LA组硬膜外分娩镇痛泵配方:罗哌卡因100 mg+舒芬太尼30μg, 生理盐水稀释至100 ml;E-LA组硬膜外分娩镇痛泵配方:罗哌卡因100 mg+舒芬太尼30 μg+艾司氯胺酮50 mg, 生理盐水稀释至100 ml。于入产房、分娩后2 h、1、7及42 d时, 采用爱丁堡产后抑郁量表(EPDS)进行评分, 分娩后7~42 d时EPDS评分≥9分诊断为PPD;并于入产房和分娩后1 d时采集外周静脉血样, 采用酶联免疫吸附法测定血清雌激素、孕激素、5-羟色胺及皮质醇的浓度。结果与C-LA组比较, E-LA组分娩后1和42 d时, EPDS评分明显降低(P<0.01), PPD发生率差异无统计学意义(1.7%/0.8%, P>0.05);入产房时血清雌激素、孕激素、5-羟色胺及皮质醇的浓度差异无统计学意义(P>0.05), 分娩后1 d时血清孕激素和皮质醇的浓度升高(P<0.05)。结论艾司氯胺酮配伍用于硬膜外分娩镇痛有助于降低PPD发生风险, 其机制与减缓分娩后血液中应激激素和性激素水平的下降速度有关。

Objective To evaluate the effect of esmketamine for labor analgesia on the occurrence of postpartum depression(PPD).Methods Two hundred and forty-two cases of nulliparous parturients who selected natural labor and agreed to receive labor analgesia were selected and divided into conventional labor analgesia group(C-LA group,n=119)and esmketamine-based labor analgesia group(E-LA group,n=123).The epidural labor analgesia solution contained ropivacaine 100 mg and sufentanil 30μg in 100 ml of normal saline in C-LA group.The epidural labor analgesia solution contained ropivacaine 100 mg,sufentanil 30μg and esketamine 50 mg in 100 ml of normal saline in E-LA group.The Edinburgh Postnatal Depression Scale(EPDS)was used to screen parturients for depression on admission to the predelivery room and at 2 h and 1,7 and 42 days after delivery,and EPDS scores were recorded.The patients were diagnosed as having PPD when EPDS score≥9 at 7-42 days after delivery.Peripheral venous blood samples were collected on admission to the predelivery room and at 1 day after delivery to determine the concentrations of serum estrogen,progesterone,5-hydroxytryptamine and cortisol by enzyme linked inmunosorbent assay.Results Compared with group C-LA,the EPDS scores were significantly decreased on the 1 and 42 days after delivery(P<0.01),no significant change was found in the incidence of PPD(1.7%/0.8%,P>0.05),no significant change was found in the concentrations of serum estrogen,progesterone,5-hydroxytryptamine and cortisol on admission to the delivery room(P>0.05),and the concentrations of serum progesterone and cortisol were significantly increased on 1 day after delivery in group E-LA(P<0.05).Conclusions Combination of esketamine is helpful in reducing the risk of postpartum depression when used for epidural labor analgesia,and the mechanism is related to slowing the declines in blood levels of sex hormones and stress hormones after delivery.