硬膜外分娩镇痛对分娩过程和分娩方式及产后抑郁的影响

宋玉荣; 詹磊; 孙莉

doi:10.16766/j.cnki.issn.1674-4152.001946

硬膜外分娩镇痛对分娩过程和分娩方式及产后抑郁的影响

doi: 10.16766/j.cnki.issn.1674-4152.001946

安徽医科大学第二附属医院妇产科，安徽合肥 230601

基金项目:

国家自然科学基金 81802586

详细信息

通讯作者:
宋玉荣，E-mail：47881721@qq.com

中图分类号: R714.3 R614.42
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- 被引次数: 0
出版历程
- 收稿日期: 2020-12-11
- 网络出版日期: 2022-02-16

Effects of epidural labour analgesia on delivery process, delivery mode and postpartum depression

Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China

摘要

摘要: 目的通过比较接受LA和非镇痛初产妇分娩相关指标和分娩后抑郁评分的差异，分析硬膜外LA对分娩过程和分娩方式以及发生产后抑郁(postpartum depression，PPD)风险的影响。方法采用前瞻性队列的研究方法，选取2019年11月—2020年2月安徽医科大学第二附属医院住院分娩的556例足月初产妇，收集其社会人口学与分娩相关资料，采用爱丁堡产后抑郁量表(EPDS)在分娩后42 d进行抑郁症状评估。分别比较宫口扩张早期(A1组)、晚期(A2组)硬膜外镇痛和非镇痛(C组)3组产妇的第一产程、第二产程、分娩方式、产钳助产、使用催产素、产后2 h总出血量、新生儿Apgar评分的情况以及EPDS评分。结果 A1组、A2组产妇第一产程、第二产程时间以及由阴道分娩转剖宫产、使用催产素的比例均高于C组产妇，差异有统计学意义(均P < 0.05)；A1组、A2组产妇出血量低于C组产妇(均P < 0.05)；A1组、A2组产妇EPDS评分以及PPD率均低于C组产妇(均P < 0.05)，经Bonferroni校正后，A1组与C组产妇剖宫产率的差异不再具有统计学意义(P>0.017)，其余组间差异有统计学意义(均P < 0.017)。多因素logistic回归分析显示，控制妊娠相关混杂因素后，LA是发生PPD的保护因素(OR=0.447，95% CI：0.245~0.818，P=0.009)。结论硬膜外LA会延长初产妇的产程，但其可以降低初产妇6周PPD的风险，总体上对母亲和新生儿都较为安全，适宜在临床上推广。
- 硬膜外 /
- 分娩镇痛 /
- 产程 /
- 分娩方式 /
- 产后抑郁
Abstract: Objective To analyse the effects of epidural labor analgesia (LA) on the process and mode of delivery and the risk of postpartum depression (PPD) by comparing labour-related indicators and postpartum depressive symptoms between LA-treated and non-analgesia groups. Methods In the prospective cohort study, 556 full-term parturient women admitted to the Second Affiliated Hospital of Anhui Medical University from November 2019 to February 2020 were included in the study. Their socio-demographic and delivery-related data were collected. Depressive symptoms were evaluated using the Edinburgh Postpartum Depression Scale (EPDS) 42 days after delivery. The first and second stages of labour, mode of delivery, forceps delivery, use of oxytocin, amount of postpartum hemorrhage two hours after delivery and neonatal Apgar and EPDS scores were compared among the early stage (A1), late stage (A2) epidural analgesia and non-analgesia (C) groups. Results The times of the first and second stages of labour and the proportion of the use of the Caesarean section and oxytocin in groups A1 and A2 were significantly higher than those in group C (all P < 0.05). Maternal blood loss in groups A1 and A2 was lower than that in group C (all P < 0.05). The EPDS scores and the prevalence rate of PPD in groups A1 and A2 were lower than those in group C (all P < 0.05). After Bonferroni correction, there was no significant difference in cesarean section rate between A1 group and C group (P>0.017), but there was still significant difference between any other two groups (all P < 0.017). Multivariate logistic regression analysis showed that LA was a protective factor for the occurrence of PPD after pregnancy-related confounding factors were controlled (OR=0.447, 95% CI: 0.245-0.818; P=0.009). Conclusion Epidural LA can prolong the stages of labour in parturient women but can reduce the risk of 6 week PPD. Overall, this treatment mode is safe for mothers and newborns and suitable for clinical use.
- Epidural /
- Labour analgesia /
- Stages of labour /
- Mode of delivery /
- Postpartum depression

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表 1 3组产妇产程、分娩方式、出血量与产后抑郁得分(率)比较 (x ±s)

组别	例数	年龄 (岁)	第一产程 [M(P₂₅，P₇₅)，min]	第二产程 [M(P₂₅，P₇₅)，min]	分娩方式[例(%)]		产钳助产 [例(%)]	使用催产素 [例(%)]	出血量 (mL)	EPDS 评分	抑郁(EPDS ≥10)[例(%)]
组别	例数	年龄 (岁)	第一产程 [M(P₂₅，P₇₅)，min]	第二产程 [M(P₂₅，P₇₅)，min]	阴道分娩	剖宫产	产钳助产 [例(%)]	使用催产素 [例(%)]	出血量 (mL)	EPDS 评分	抑郁(EPDS ≥10)[例(%)]
A1组	99	28.2±2.7	775.0(532.5, 913.3)^a	56.0(31.5, 85.5)^a	86(86.9)^b	13(13.1)^b	4(4.0)	86(86.9)^a	346.3±119.5^a	6.4±2.7^a	14(14.1)^a
A2组	234	27.9±3.2	655.0(480.0, 820.0)^a	45.0(29.0, 78.0)^a	188(80.3)^a	46(19.7)a	9(3.8)	191(81.6)^a	322.9±72.8^a	6.2±2.8^a	30(12.8)^a
C组	223	27.6±3.0	450.0(300.0, 630.0)	34.0(23.5, 56.0)	209(93.7)	14(6.3)	7(3.1)	105(47.1)	357.2±83.5	8.1±3.0	59(26.5)
统计量		2.325^c	76.232^d	19.739^d	17.923^e		0.233^e	81.833^e	21.938^c	53.060^c	15.602^e
P值		0.313	< 0.001	< 0.001	< 0.001		0.890	< 0.001	< 0.001	< 0.001	< 0.001
注：与C组比较，^aP < 0.017，^bP < 0.05。^c为F值，^d为H值，^e为χ²值。

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表 2 产妇伴发产后抑郁的影响因素的多因素logistic回归分析

变量	B	SE	Wald χ²	P值	OR(95% CI)
年龄	0.098	0.039	6.317	0.012	1.103(1.022~1.190)
是否镇痛	-0.804	0.308	6.817	0.009	0.447(0.245~0.818)

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