局部麻醉与静脉镇静下接受手术终止妊娠的女性的疼痛、皮质醇水平及心理困扰比较
Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation.
作者信息
Suliman Sharain, Ericksen Todd, Labuschgne Peter, de Wit Renee, Stein Dan J, Seedat Soraya
机构信息
MRC Research Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, Cape Town, South Africa.
出版信息
BMC Psychiatry. 2007 Jun 12;7:24. doi: 10.1186/1471-244X-7-24.
BACKGROUND
The weight of evidence suggests that women who freely choose to terminate a pregnancy are unlikely to experience significant mental health risks, however some studies have documented psychological distress in the form of posttraumatic stress disorder and depression in the aftermath of termination. Choice of anaesthetic has been suggested as a determinant of outcome. This study compared the effects of local anaesthesia and intravenous sedation, administered for elective surgical termination, on outcomes of pain, cortisol, and psychological distress.
METHODS
155 women were recruited from a private abortion clinic and state hospital (mean age: 25.4 +/- 6.1 years) and assessed on various symptom domains, using both clinician-administered interviews and self-report measures just prior to termination, immediately post-procedure, and at 1 month and 3 months post-procedure. Morning salivary cortisol assays were collected prior to anaesthesia and termination.
RESULTS
The group who received local anaesthetic demonstrated higher baseline cortisol levels (mean = 4.7 vs 0.2), more dissociative symptoms immediately post-termination (mean = 14.7 vs 7.3), and higher levels of pain before (mean = 4.9 vs 3.0) and during the procedure (mean = 8.0 vs 4.4). However, in the longer-term (1 and 3 months), there were no significant differences in pain, psychological outcomes (PTSD, depression, self-esteem, state anxiety), or disability between the groups. More than 65% of the variance in PTSD symptoms at 3 months could be explained by baseline PTSD symptom severity and disability, and post-termination dissociative symptoms. Of interest was the finding that pre-procedural cortisol levels were positively correlated with PTSD symptoms at both 1 and 3 months.
CONCLUSION
High rates of PTSD characterise women who have undergone surgical abortions (almost one fifth of the sample meet criteria for PTSD), with women who receive local anaesthetic experiencing more severe acute reactions. The choice of anesthetic, however, does not appear to impact on longer-term psychiatric outcomes or functional status.
背景
大量证据表明，自主选择终止妊娠的女性不太可能面临重大心理健康风险，然而一些研究记录了终止妊娠后出现的创伤后应激障碍和抑郁等心理困扰。麻醉方式的选择被认为是影响结果的一个因素。本研究比较了局部麻醉和静脉镇静用于选择性手术终止妊娠时，对疼痛、皮质醇和心理困扰结果的影响。
方法
从一家私立堕胎诊所和州立医院招募了155名女性（平均年龄：25.4±6.1岁），在终止妊娠前、手术后即刻、术后1个月和3个月，使用临床医生进行的访谈和自我报告测量方法，对她们在各个症状领域进行评估。在麻醉和终止妊娠前收集早晨唾液皮质醇检测样本。
结果
接受局部麻醉的组表现出更高的基线皮质醇水平（平均值=4.7对0.2），终止妊娠后即刻有更多的分离症状（平均值=14.7对7.3），以及手术前（平均值=4.9对3.0）和手术期间（平均值=8.0对4.4）更高的疼痛水平。然而，从长期来看（1个月和3个月），两组在疼痛、心理结果（创伤后应激障碍、抑郁、自尊、状态焦虑）或残疾方面没有显著差异。3个月时创伤后应激障碍症状超过65%的变异可由基线创伤后应激障碍症状严重程度和残疾以及终止妊娠后的分离症状来解释。有趣的是，术前皮质醇水平与1个月和3个月时的创伤后应激障碍症状呈正相关。
结论
接受手术流产的女性中创伤后应激障碍发生率很高（近五分之一的样本符合创伤后应激障碍标准），接受局部麻醉的女性经历更严重的急性反应。然而，麻醉方式的选择似乎对长期精神结果或功能状态没有影响。
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