Kaur Amrit, Mitra Sukanya, Singh Jasveer, Sarna Rashi, Pandher Dilpreet Kaur, Saroa Richa, Das Subhash
Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
Saudi J Anaesth. 2020 Oct-Dec;14(4):473-479. doi: 10.4103/sja.SJA_814_19. Epub 2020 Sep 24.
Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed.
Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery ( = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD.
Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86-43.55; = 0.001).
CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.
疼痛与抑郁相关，但分娩镇痛在分娩期间有效缓解疼痛是否能降低产后抑郁症（PPD）的发病率尚不确定。这项随机对照研究评估了腰麻-硬膜外联合（CSE）分娩镇痛是否与PPD风险降低相关。还评估了其他已报道的PPD风险因素。
将产妇随机分为CSE分娩镇痛组或正常阴道分娩组（每组65例）。CSE组产妇鞘内注射0.5 ml 0.5%的重比重布比卡因，并采用患者自控硬膜外镇痛（PCEA），持续输注0.1%的左旋布比卡因和2 μg/ml芬太尼，速率为5 ml/h，同时患者自控追加剂量，锁定时间间隔为15分钟。两组产妇均使用爱丁堡产后抑郁量表（EPDS）在产后第3天评估抑郁症状，并在产后6周评估PPD（主要结局；定义为产后6周EPDS评分≥10分）。次要结局包括疼痛评分、产妇满意度以及1分钟和5分钟时的阿氏评分。还对产妇进行了几种PPD风险因素的筛查。
PPD发病率为22.3%。CSE组与对照组之间PPD发病率的差异不显著（27.7%对16.9%；Fisher精确检验P = 0.103）。在逻辑回归模型分析的所有风险因素中，孕期感知压力是PPD发生的唯一显著预测因素（调整后的优势比为11.17，95%置信区间为2.86 - 43.55；P = 0.001）。
分娩期产妇采用CSE镇痛并不能降低产后6周的PPD发病率。相反，孕期感知到的高压力似乎是最重要的因素。
