初产妇产后抑郁症相关因素及治疗效果的临床研究

Clinical study on affecting factors and curative effects of primipara with postpartum depression

目的通过对初产妇患产后抑郁的情况进行调查研究,分析其主要的影响因素,对比干预措施的疗效,最终以找到能够有效改善初产妇抑郁症状的疗法。方法对482例孕妇在妊娠期采用焦虑自评量表(SAS)、抑郁自评量表(SDS)进行问卷调查;其中478例应用爱丁堡产后抑郁量表(EPDS)跟踪调查8周。并将产后抑郁产妇按照简单随机抽样法分为对照组和研究组(其中对照组采用药物治疗,研究组采用心理加药物综合治疗8周),采用蒙哥马利抑郁量表(MADRS)评定疗效,副反应量表(TESS)评定不良反应;计量资料采用t检验,计数资料采用χ2检验,P<0.05表示差异有统计学意义。结果跟踪调查478例产妇,发现EPDS≥13分者76例,占15.90%(76/478),孕期SDS≥53分者32例,占6.69%(32/478),孕期SAS≥50分者61例,占12.66%;采用单因素和多元回归分析,产后抑郁症与年龄、孕期焦虑或抑郁情绪为负相关,分娩认知情况、产后丈夫及家人照顾情况、产后睡眠状况、新生儿健康情况为正相关;治疗后2、4、6及8周后研究组的MADRS评分较治疗前均明显改善(P值分别为0.041、0.032、0.028、0.008,均<0.05),同样对照组治疗后MADRS评分也较治疗前有显著下降(P值分别为0.044、0.038、0.035、0.011,均<0.05),且研究组的疗效明显好于对照组(P值分别为0.022、0.025、0.032、0.013,均<0.05);2组产妇在治疗后与治疗前相比TESS评分均升高,但2组治疗后比较差异无统计学意义(P>0.05);4周后2组产妇TESS评分均有降低的趋势。结论调查发现孕期有焦虑抑郁等不良情绪的产妇易患产后抑郁症,且产后抑郁症是多种因素共同作用的结果,而采用药物联合心理干预治疗产后抑郁症的效果比单独药物治疗好。

Objective Through studying the situation and the main influence factors of primipara＇ s postpartum depres- sion,so as to find the main influencing factors and the most effective therapy to improve primipara＇ s depressive symp- toms. Methods Self-assessment lists of anxiety （SAS） and depression self rating scale （SDS） were used to investigate and evaluate 482 cases of pregnant women during pregnancy;among them,478 eases of them were followed and investiga- ted by the application of Edinburgh postpartum depression scale（EPDS） in the next 6 weeks;and primipara with postpar- tum depression was randomly divided into 2 groups： Group A using drug therapy and Group B having drug therapy com- bined with psychotherapy,all for weeks;also Montgomery Asberg Depression Rating Scale（MADRS） was used to evaluate the curative effect,while side effect scale（TESS） was used to evaluate the adverse reactions. T test and 2 test were used to analyze data. Results After tracking investigation of 478 maternal cases,there were 76 cases whose EPDS scoring above 13 points, accounting for 15.90% （76/478）, and 32 cases （6.69%） whose SDS scoring above 53 points ;single factor and multiple regression analysis were used to study the relationship between postpartum depression and age, anxiety or depres- sion during pregnancy, childbirth, cognitive situation, postpartum husband and family care, postpartum sleep and newborn health ;2,4,6 and 8 weeks after treatment psychological drug group＇s MADRS scores were significantly decreased than before treatment（ P values were 0. 041,0.032,0. 028 and 0. 008 separately, 〈 0.05 ） , the same as MADRS scores of the drug treatment group（ P values were 0.044,0. 038,0. 035 and 0.011 separately, 〈 0.05 ）, but the decreasing effects of Group B was much better than that in Group A （ P values were 0.022,0. 025,0.032 and 0.013 separately, 〈 0.05 ） ; After treatment in both groups, TESS scores were significantly higher（ P 〈 0.05 ）, but there was no difference between the two groups（P 〉0.05） ;and the maternal TESS scores of the two groups after 4 weeks all had a tendency to reduce. Conclu- sion Survey found that pregnant women with bad emotions such as anxiety were susceptible to have postpartum depres- sion,and postpartum depression was the outcome of combined action of many factors iand using drug psychological inter- vention for the treatment of postpartum depression was better than single drug therapy.