产后抑郁三阶梯预防模式的初步研究

The pilot study about three-step ladder model of postpartum depression prevention

目的探讨产后抑郁症(postpartum depression,PPD)产前、产时、产后三阶梯预防模式。方法收集2009年1月至2010年1月广东省第二人民医院孕妇310例为观察组,外院孕妇172例为对照组。产前:妊娠12周、28周、36周时分别进行焦虑和抑郁问卷调查,观察组除进行常规的孕妇学校培训外,发现焦虑和抑郁状态进行心理干预,对照组只进行常规的孕妇学校培训;产时:观察组在宫口开大3cm时进行硬膜外阻滞分娩镇痛,对照组常规产时护理;产后:3周、6周随访进行艾迪产后抑郁量表(Edinburgh postpartumdepression scale,EPDS)评分,对焦虑和抑郁状态进行干预,PPD患者给予药物和心理干预相结合的治疗方法。结果两组妊娠12周抑郁自评量表(self-rating depression scale,SDS)和焦虑自评量表(self-ratinganxiety scale,SAS)初筛评分差异无统计学意义(P>0.05),28周、36周SAS和SDS评分差异有统计学意义(P<0.05);两组第3产程末雌二醇(estradiol,E2)、孕酮(progesterone,P)差异有统计学意义(P<0.05),催乳素(prolactin,PRL)差异无统计学意义(P>0.05),产后7天E2、P、PRL差异有统计学意义(P<0.05);产后3周、6周的EPDS评分和PPD的发病率比较差异有统计学意义(P<0.05)。结论产前、产时、产后三阶梯预防PPD模式有效,并具有较好的可行性。

Objective To discuss three -step ladder model of postpartum depression （PPD） prevention during pregnancy, delivery and puerperium. Methods Chosen 310 cases from Guangdong Provincial the Second People＇s Hospital were in study group between January 2009 and January 2010, while 172 cases as control group enrolled in from other hospital within the same period. During antepartum the questionnaire of self - rating anxiety scale（SAS） and self- rating depression scale（SDS） were taken to all pregnancy women in 12w, 28w, 36w of gestation weeks respectively. In study group, proper psychological interference was given for cases in the state of anxiety and depression according to the criteria of SAS and SDA besides relevant antenatal education and training. While in control group, just relevant antenatal education and training was given. During intra - partum the gravidas in study group received peridural anesthesia when cervix opened to 3 cm; while gravidas in control group just received routine nursing care during delivery. During postpartum all cases were followed up until 3w, 6w after childbirth and taken Edinburgh Postnatal Depression Scale （EPDS）. If they were in the stage of depression, psychological interference was given. If women were PPD, psychosocial and the pharmacotherapy were received. Results There was no significant difference of SAS and SDS between two groups in week 12 of pregnancy（P 〉0. 05）. However, in week 28 and 36 of pregnancy, SAS and SDS were changed and showed statistic difference between two groups （ P 〈 0. 05）. The differences of estradiol （E2 ） and progesterone （P） were significant between two groups during the late third stage of labor（ P 〈 0. 05 ）, while PRL was no significant difference（ P 〉 0.05 ）. After 7 days of childbirth, the difference of E2, P and PRL in study group were significant comparing with those in control group（ P 〈 0.05）. After 3, 6 weeks, the difference of EPDS scores and the morbidity of PPD were significant between two groups（ P 〈 0. 05 ）. Conclusion It is fairly feasible of three - step ladder model of PPD prevention during antepartum, intrapartum and postpartum