| Objective: To observe the effects of esketamine used for postoperative analgesia in patients undergoing cesarean section on postpartum anxiety and depression and the expression levels of IL-6,TNF-α and Cor,and to investigate the possible mechanisms by means of which esketamine improves postpartum anxiety and depressionMethods: 230 parturients who intended to receive a cesarean section under combined spinal-epidural anesthesia were choosed and randomized into two groups: esketamine group and control group.All patients received PCIA.ES group: 0.75mg/kg esketamine + butorphanol0.175mg/kg + tropisetron 5mg;C group: sufentanil 50 ug + butorphanol0.175mg/kg + tropisetron 5mg.Observation items: 1.Record general data such as age,height,weight,BMI,frequency of pregnancy,days of pregnancy,the amount of bleeding during surgery and time of surgery in ES group and C group.2.Pain and sedation scores were assessed at 4h,12 h,24h and 48 h postoperatively with VAS and Ramsay sedation score for both groups.3.SAS and EPDS were used to assess patients’ anxiety and depression 1 day before surgery,3 days,7 days and 1 month after surgery.4.The time of first postpartum defecation,time of first bowel movement,time of first bed removal and length of postpartum hospital stay were recorded for parturient in ES group and C group.5.Note the number of negative reactions for instance nausea and vomiting,giddiness and headache,respiratory inhibition,drowsiness,and neurological excitement symptoms(delirium,delusions,hallucinations)within 48 hours after surgery.6.The plasma levels of IL-6,Cortisol,and TNF-αwere measured 1 day before and 48 hours after surgery in both groups.Results: 1.No differences in general data of maternal such as age,height,weight,BMI,frequency of pregnancy,days of pregnancy,time of operation and intra-operative bleeding between the ES group and C group(P>0.05).2.There was no obvious difference in VAS scores in both groups at 4h,12 h,24h and 48 h postoperatively(P>0.05).A significant higher Ramsay score was observed in the ES group compared to the C group at 12 h and 24 h postoperatively(P< 0.05),but the Ramsay score of4 h and 48 h after surgery was not statistically significant(P>0.05).3.There were no obvious differences in SAS scores in both groups before surgery(P>0.05).Patients in the ES group had lower SAS scores on days3 and 7 after surgey(P<0.05).No obvious difference was found in SAS scores at 1 month postoperatively between the ES group and C group(P>0.05);The incidence of anxiety in the ES group was lower than that in the C group at 7 days after surgery(P<0.05),but not at 3 days and1 month after surgery(P>0.05).4.No significant differences were found in the EPDS scores between the two groups preoperatively(P>0.05).EPDS scores were lower in the ES group than in the C group at 3 and 7days after surgery(P < 0.05),No obvious difference was found in EPDS scores at 1 month postoperatively between the ES group and C group(P > 0.05);The incidence of postnatal depression was significantly lower in the ES group than in the C group at 7 days after surgery,without significant differences at 3 days and 1 month after surgery.5.NO difference between the ES group and C group in the postpartum recovery indicators such as time to first defecation,time to first postpartum defecation,time to first bed removal,and length of postpartum hospital stay(P > 0.05).6.Within 48 h after surgery,no obvious difference in adverse events for instance nausea and vomiting,giddiness and headache,respiratory inhibition,drowsiness,and neurological excitement symptoms(delirium,delusions,hallucinations)between the two groups(P > 0.05).7.Preoperative and postoperative plasma levels of IL-6,TNF-α and Cor in two groups: There were no statistically significant differences in preoperative levels of IL-6,TNF-α and Cor in two groups(P > 0.05).The postoperative levels of IL-6,TNF-α and Cor in the plasma of ES group were significantly lower than those in the C group(P < 0.05).The levels of IL-6 and Cor of group C were significantly increased after surgery(P< 0.05).Conclusion: 1.Esketamine can effectively relieve postoperative pain,ameliorate postpartum anxiety and depression,and lower the incidence of postpartum anxiety and depression in women who have had a cesarean section.2.Activation of IL-6,TNF-α and Cor was present in the postoperative period in women undergoing caesarean section and esketamine reduces the levels of IL-6,TNF-α and Cor in the postoperative period.3.The analgesic and anti-anxiety and depressive effects of esketamine may be related to the suppression of expression of IL-6,TNF-α and Cor. |
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