妊娠期生物反馈训练降低产后抑郁发生风险效果的前瞻性随机对照研究

Biofeedback training during pregnancy decreases the risk of postpartum depression： a prospective randomized controlled trial

目的 探讨生物反馈训练降低产后抑郁高危孕妇产后抑郁发生风险的效果. 方法 2010年5月1日至12月31日,在北京军区总医院妇产科建立围产保健档案并分娩,且妊娠12～14周爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale,EPDS）评分为6～12分的产后抑郁高危孕妇60例,随机分为训练组和对照组,各30例.对照组学习孕妇学校课程,训练组在此基础上使用生理相干与自主平衡系统进行自我生物反馈训练至预产期前1周.训练组和对照组均在入组时,以及产后3d、6周和3个月采用EPDS进行评定,使用重复测量混合效应模型对组间、时间点间EPDS评分进行统计学分析. 结果 共51例孕产妇（训练组25例、对照组26例）完成试验.入组时训练组与对照组的EPDS评分差异无统计学意义[（8.5±2.0）分与（8.5±1.9）分,t=0.03,P=0.97].训练组产后3d、6周和3个月时EPDS评分分别为（4.1±1.8）、（4.7±2.0）和（4.6±1.8）分,均低于对照组[分别为（6.5±2.4）、（7.0±2.5）和（6.9±2.4）分]（分组与测量时间交互效应分析F=4.35,P=0.01）.3个时间点OR值（95％CI分别为0.12（0.03～0.45）、0.21（0.06～0.68）和0.23（0.07～0.77）,P值均＜0.05.3个时间点效应量Cohen＇s d值分别为1.17、0.99和1.06,表明与基线值相比,2组在各时间点EPDS总分均有下降,训练组更为显著. 结论 生物反馈训练能有效改善产后抑郁高危孕妇的抑郁情绪,降低其产后抑郁的发生风险.

Objective To explore the clinical function of biofeedback training in patients with high risks of postpartum depression, and to provide a new method to decrease the risk of postpartum depression. Methods From May l, to December 31, 2010, in Bayi Children＇s Hospital, General Hospital of Beijing Mititary Area Command of Chinese PLA, 60 pregnant women with Edinburgh Postnatal Depression Scale （ EPDS ） evaluation score of 6 to 12 at 12-14 gestational weeks were randomly divided into the biofeedback training group （ n=30 ） and the control group （ n=30 ） . The control group learned prenatal care knowledge in pregnant women＇s school. Moreover, the biofeedback training group received Self-generate Physiological Coherence System training till one week before delivery. Both groups were evaluated with the EPDS at baseline, and 3 days, 6 weeks, 3 months postpartum. Differences between the two groups were compared with mixed effect model. Results Totally, there were 51 pregnant women finished the study, including 25 women in the biofeedback training group and 26 in the control group. There were no statistical difference in EPDS score at 12-14 gestational weeks between the biofeedback training group and control group [8.5±2.0 vs 8.5± 1.9, t=0.03, P=0.97]. At 3 days, 6 weeks and 3 months postpartum, the EPDS score of biofeedback training group was 4.1 ± 1.8, 4.7± 2.0 and 4.6 4,1.8 respectively, which was lower than those in the control group （ 6.5 4, 2.4, 7.0± 2.5 and 6.9±2.4 ） （ interaction effect F=4.35, P=0.01 ） . On each postpartum time-point, OR value and 95%CI was 0.12 （ 0.03-0.45 ） , 0.21 （ 0.06-0.68 ） and 0.23 （ 0.07-0.77 ） ,P〈0.05 respectively. Cohen＇s d value were 1.17, 0.99 and 1.06 respectively. Compared with the baseline value, the total EPDS scores in each study stage declined with varied degrees in both groups, and the score-reducing level were obvious in the biofeedback training group than in the control group. Conclusion Biofeedback training could effectively relieve the depression symptoms in pregnant women with high risks of postpartum depression, and decrease the risk of postpartum depression.