硬膜外分娩镇痛对产妇产后抑郁的影响

Effects of labor epidural analgesia on postpartum depression

目的评估硬膜外分娩镇痛(LEA)对产妇产后抑郁(PPD)的影响。方法选择经阴道分娩的初产妇628例,年龄20~36岁,BMI 20~35 kg/m 2,ASAⅡ或Ⅲ级。根据产妇是否接受硬膜外分娩镇痛分为两组:镇痛组(n=322)和非镇痛组(n=306)。记录分娩期间VAS疼痛评分最高值、产程时间、出血量、新生儿1、5 min Apgar评分和新生儿入NICU的发生情况。于分娩前1周和产后2周、6周分别采用爱丁堡产后抑郁量表(EPDS)评估PPD发生情况(EPDS评分≥11分为PPD),采用广泛性焦虑量表(GAD-7)评估产妇焦虑情绪,采用领悟社会支持量表(PSSS)评估产妇感受到的总社会支持度。结果与非镇痛组比较,镇痛组产妇分娩期间VAS疼痛评分最高值明显降低(P<0.05)。两组产妇第一产程时间、第二产程时间、出血量、新生儿1、5 min Apgar评分、新生儿入NICU比例差异无统计学意义。两组产妇产后2、6周PPD发生率、PSSS高支持状态、GAD-7≥10分差异无统计学意义。结论初产妇接受LEA不影响产后抑郁的发生风险。

Objective To investigate the effect of labor epidural analgesia(LEA)on postpartum depression(PPD).Methods A total of 628 primiparous,aged 20-36 years,BMI 20-35 kg/m 2,ASA physical statusⅡorⅢ,and delivering vaginally were enrolled.According to maternal choice of receiving epidural labor analgesia or not,primiparous were divided into two groups:analgesic group(n=322)and non-analgesic group(n=306).VAS pain scores,duration of labor,postpartum hemorrhage,Apgar scores of newborns,and proportion of neonates admitted to the NICU were recorded.The Edinburgh postpartum depression scale(EPDS)was used to assess the occurrence of PPD(EPDS score≥11 considered positive for postpartum depression),the generalized anxiety disorder 7-item scale(GAD-7)was used to assess maternal anxiety,and the perceived social support scale(PSSS)was used to assess total social support at 1 week before delivery,2 and 6 weeks after delivery,respectively.Results Compared with the non-analgesic group,the VAS pain score during labor was significantly lower in the analgesic group(P<0.05).The first stage of labor duration,the second stage of labor duration,postpartum hemorrhage,1 minute and 5 minutes Apgar scores for newborns,and the proportion of neonatal admitted to NICU were not statistically significant.The incidence of PPD,PSSS high support state,and GAD-7≥10 at 2 and 6 weeks after delivery had no statistically significant between the two groups.Conclusion There was no significant difference in the risk of postpartum depression between primiparous receiving epidural labor analgesia or not.