硬膜外阻滞分娩镇痛对产后抑郁症的影响

Effect of epidural block anesthesia of labor on puerperal depression

目的:探讨硬膜外阻滞分娩镇痛对产后抑郁症的影响,验证分娩镇痛能降低产后抑郁症生物-心理-社会学效应的设想。方法:2005年8～11月广东省第二人民医院采用硬膜外阻滞分娩镇痛并阴道分娩的初产妇121例为研究组,同期未采取任何分娩镇痛技术的广州市内其他3家医院阴道分娩的初产妇97例为对照组,在第3产程末和产后7天进行雌二醇(E2)、孕酮(P)、催乳素(PRL)、内皮素-1(ET-1)、皮质醇(CORT)检测;产后3天和产后7天进行EPDS评分。结果:两组间比较:第3产程末和产后7天E2、P、ET-1、CORT值差异均有显著性(P<0.05),研究组E2、P明显高于对照组,ET-1、CORT明显低于对照组;PRL差异无显著性(P>0.05)。两组组内比较:第3产程末与产后7天E2、P、ET-1、CORT差异均有显著性(P<0.001),PRL值差异无显著性(P>0.05)。研究组产后7天、14天EPDS评分及产后14天抑郁症发生率比较明显低于对照组(P<0.05)。结论:硬膜外阻滞分娩镇痛能降低产后抑郁症的生物-心理-社会学效应,是降低产后抑郁症发病率的重要途径之一。

Objective. To explore the influence of epidural block anesthesia of labor on puerperal depression and to test and verify the hypothesis that anesthesia of labor can decrease the effect of puerperal depression on the organism - psychology - sociology. Methods： 121 primipara of spontaneous labor who accepted epidural block anesthesia of labor in the Second People＇s Hospital of Guangdong Province from August, 2005 to November, 2005 were chosen as the experimental group, 97 parturient of spontaneous labor who did not accept any anesthesia of labor in other three hospitals of Guangzhou city at the same time as the control group. Monitoring the numerical value of E2 , P, PRL, ET - 1 and CORT at the end of the third stage of labor and the postpartum seventh day. Made EPDS scores in the postpartum third day and the postpartum seventh day. Results： At the end of third stage of labor and postpartum seventh day, there were significant differences in the levels of E2, P, ET- 1 and CORT （P 〈 0. 05 ～ 0. 01 ） between the two groups. The levels of E2 and P in the experimental group were significantly higher than those in the control group. But the levels of ET-1 and CORT in the experimental group were significantly lower than those in the control group. There was no significant difference in the levels of PRL （P 〉 0. 05 ） . In the same group, at the end of the third stage of labor and the postpartum seventh day, there were significant differences in the levels of E2, P, ET- 1 and CORT （P 〈 0. 001 ） ; while there was no significant difference in the levels of PRL （P 〉 0. 05 ） . Scores of EPDS in the seventh day and the fourteen day after labor and the incidence of puerperal depression state in the fourteen day after labor in the experimental group were significantly lower than those in the control group （ P 〈 0. 02 ～ 0. 05） . Conclusion： Epidural block anesthesia of labor can decrease the effect of puerperal depression on the organism - psychology - sociology. Anesthesia of labor is one of the important ways to decrease the incidence of puerperal depression state.