摘要译文（供参考）

艾司氯胺酮干预与剖宫产后抑郁和镇痛之间的关联：系统评价和荟萃分析

目的： 本研究旨在比较使用艾司氯胺酮降低剖宫产后抑郁和疼痛风险的有效性和安全性。

数据来源： 在 PubMed、Embase、Cochrane Library、Web of Science、CNKI 和 Wan Fang 中进行了文献检索，检索时间从建库到 2023 年 8 月。

研究资格标准： 纳入标准均为随机对照试验，受试者为剖宫产患者，随机接受艾司氯胺酮干预，不分年龄或种族。评估的结局包括产后 7 天内和分娩后 28 至 42 天的产后抑郁发生率和爱丁堡产后抑郁量表评分、疼痛评分 （视觉模拟量表或数字评定量表，0-10）、阿片类药物的消耗量以及术中和术后不良事件。

方法： Cochrane 协作网的工具用于纳入研究的质量评估。使用 Review Manager 5.3 软件对数据进行统计分析，结果表示为平均差和 95% 置信区间。使用随机效应或固定效应模型合并评估。使用标准 I 评估研究异质性2统计。

结果： 在纳入的 11 项使用爱丁堡产后抑郁量表进行产后抑郁评估的随机对照试验中，艾司氯胺酮组患者在手术后一周内发生产后抑郁的风险较低 （风险比，0.45;95% 置信区间，0.33-0.62）。术中使用艾司氯胺酮在术后维持较低的爱丁堡产后抑郁量表评分 （平均差，-1.64;95% 置信区间，-2.14 至 -1.14）。就其他结局而言，艾司氯胺酮与有益效果相关，包括 48 小时内疼痛评分显着下降（平均差，-0.71;95% 置信区间，-0.89 至 0.52）。艾司氯胺酮增加了手术期间发生不良神经和精神事件的风险，但不影响健康，与对照组相比，分娩后无显著差异。

结论： 艾司氯胺酮可能会在短期内降低剖宫产患者患产后抑郁症的风险。此外，作为减少镇痛的辅助手段，艾司氯胺酮也有效协助疼痛管理。由于缺乏更多高质量的证据，我们需要更令人信服的证据来证实艾司氯胺酮在改善产后恢复方面的价值。

关键词： 剖宫产;抑郁症;艾司氯胺酮;术后镇痛;产后抑郁症。

原文摘要

Association between esketamine interventions and postpartum depression and analgesia following cesarean delivery: a systematic review and meta-analysis

Objective: This study aimed to compare the efficacy and safety of the use of esketamine to reduce the risk for postpartum depression and pain after cesarean delivery.

Data sources: Literature searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wan fang from inception to August 2023.

Study eligibility criteria: The eligibility criteria were all randomized controlled trials of people who underwent a cesarean delivery and who were randomized to receive esketamine interventions irrespective of age or ethnicity. The outcomes that were assessed included the incidence of postpartum depression and the Edinburgh Postnatal Depression Scale score within 7 days and at 28 to 42 days after delivery, the pain score (visual analog scale or numerical rating scale, 0-10), the consumption of opioids, and intraoperative and postoperative adverse events.

Methods: The Cochrane collaboration's tool was used for quality appraisal of the included studies. Statistical analysis of the data was performed using Review Manager 5.3 software, and the results were expressed as mean differences with 95% confidence intervals. Assessments were pooled using a random-effects or fixed-effects model. Study heterogeneity was assessed using the standard I2 statistic.

Results: Among the 11 included randomized controlled trials that used the Edinburgh Postnatal Depression Scale for postpartum depression assessment, patients in esketamine group had a lower risk for postpartum depression within a week of surgery (risk ratio, 0.45; 95% confidence interval, 0.33-0.62). Intraoperative use of esketamine maintained a lower Edinburgh Postnatal Depression Scale score after surgery (mean difference, -1.64; 95% confidence interval, -2.14 to -1.14). Esketamine was associated with a beneficial effect in terms of the other outcomes, including a significant decline in pain score within 48 hours (mean difference, -0.71; 95% confidence interval, -0.89 to 0.52). Esketamine increased the risk for adverse neurologic and mental events during surgery without harming health, and there was no significant difference after delivery when compared with the control group.

Conclusion: Esketamine may reduce the risk for postpartum depression among patients who are undergoing cesarean delivery in the short term. In addition, as an adjunct to reduce analgesia, esketamine also effectively assists in pain management. Because of the lack of more high-quality evidence, we need more compelling evidence to confirm the value of esketamine in improving postpartum recovery.

Keywords: cesarean delivery; depression; esketamine; postoperative analgesia; postpartum depression.