椎管内分娩镇痛与产后 2 年母亲抑郁风险降低相关：一项多中心、前瞻性、纵向研究。
Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study.
机构信息
From the Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital (Z-HL, S-TH, C-MD, TD, D-XW), Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital (M-JX), Department of Anesthesiology, Haidian Maternal & Child Health Hospital (LW) and Department of Biostatistics, Peking University First Hospital, Beijing, China (X-YL).
出版信息
Eur J Anaesthesiol. 2019 Oct;36(10):745-754. doi: 10.1097/EJA.0000000000001058.
BACKGROUND
Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression.
OBJECTIVE
To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression.
DESIGN
This was a multicentre, prospective, longitudinal study.
SETTING
The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017.
PATIENTS
Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled.
MAIN OUTCOME MEASURE
Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model.
RESULTS
Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023).
CONCLUSION
For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.
TRIAL REGISTRATION
www.chictr.org.cn: ChiCTR-OCH-14004888 and ClinicalTrials.gov: NCT02823418.
背景
剧烈的分娩疼痛是产后抑郁的一个重要危险因素，而早期抑郁与长期抑郁的风险增加有关；而分娩时使用硬膜外镇痛则降低了产后抑郁的风险。
目的
探讨分娩时使用神经轴索镇痛是否与降低 2 年抑郁风险有关。
设计
这是一项多中心、前瞻性、纵向研究。
地点
研究于 2014 年 8 月 1 日至 2017 年 4 月 25 日在中国北京的北京大学第一医院、北京妇产医院和海淀妇幼保健院进行。
患者
纳入 599 名单胎足月头位妊娠、准备阴道分娩的初产妇。
主要观察指标
在分娩室入院时、产后 6 周和产后 2 年进行抑郁症状筛查。采用爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale），以 10 分为界值。主要终点为产后 2 年抑郁。采用多变量逻辑回归模型分析神经轴索分娩镇痛与 2 年抑郁发生的关系。
结果
508 名产妇完成了 2 年随访。其中，368 名（72.4%）在分娩时接受了神经轴索镇痛，140 名（27.6%）未接受。接受神经轴索分娩镇痛的产妇 2 年抑郁发生率低于未接受者（7.3%[27/368] vs. 13.6%[19/140]；P=0.029）。校正混杂因素后，分娩时使用神经轴索镇痛与 2 年抑郁发生风险显著降低相关（比值比 0.455，95%置信区间 0.230 至 0.898；P=0.023）。
结论
对于单胎足月头位妊娠、计划阴道分娩的初产妇，分娩时使用神经轴索镇痛可降低产后 2 年发生母亲抑郁的风险。
试验注册
www.chictr.org.cn：ChiCTR-OCH-14004888 和 ClinicalTrials.gov：NCT02823418。
Zotero 插件