自控镇痛对剖宫产产后抑郁症发病率影响的研究

Research in influence of patient-controlled analgesia on incidence of postpartum depression after cesarean section

目的探讨硬膜外自控镇痛（PCEA）对剖宫产产后抑郁症发病率的影响。方法将256例单胎足月初次剖宫产妇随机分为研究组130例和对照组126例，研究组产妇术后保留硬膜外导管与镇痛泵连接，注入镇痛液镇痛，对照组产妇术后拔管，术后4~6h肌肉注射盐酸哌替啶100mg，6h后重复1次，总量200mg。术后观察48h，用放射免疫分析法测定产前、产后24，48h血浆催乳素（PRL）的浓度。产后6周采用爱丁堡产后抑郁量表（EPDS）对2组产妇进行评定，比较2组产妇产后抑郁症的发病率，并进行比较。结果研究组产妇产后24，48h血浆PRL水平均明显高于对照组，研究组产妇抑郁症发病率为6．15％，而对照组产妇抑郁症发病率为16．67％，2组比较差异显著。结论剖宫产术后应用自控镇痛可明显地降低产妇产后抑郁症的发病率，对预防产后抑郁症的发生具有非常重要的现实意义。

Objective To explore the influence of patient-controlled epidural analgesia（PCEA） on incidence of postpartum depression after cesarean section. Methods 256 cases of singleton term primary cesarean delivery were randomly divided into the study group（ 130 cases）and the control group（ 126 cases）. The study group retained analgesia pump connected with epidural catheter, analgesic liquid was injected. In the control group, epidural catheter was removed, and was given intramuscular injection of pethidine hy- drochloride 100 mg 4~6 h after operation, repeated 6 h later, total dosage was 200 mg. Postoperative obser- vation time was 48h. Plasma prolactin（PRL） concentration was determined by radioimmunoassay in prena- tal, postnatal 24 h and 48 h. Edinburgh postnatal depression scale （EPDS） was used to assess depression state 6 weeks postpartum in the two groups. The incidence of postpartum depression was compared between two groups. Results The plasma PRL level in the study group was significantly higher than the control group 24 h, 48 h postpartum. The incidence rate of depression in the study group was 6.15%, while was 16.67% in the control group, the differences were statistically significant. Conclusions The application of PCEA after cesarean section can significantly reduce the incidence of postpartum depression, and has very important practical significance in preventing the incidence of postpartum depression.