Effect of remifentanil intravenous patient-controlled intravenous analgesia on postpartum depression
-
摘要:
目的 研究瑞芬太尼静脉自控分娩镇痛对产后抑郁的影响。 方法 选取2014年3月~2017年3月入我院妇产科进行分娩的单胎头位足月初产妇 66例作为研究对象。采用随机数字表法将产妇分为瑞芬太尼组(n=22)、硬膜外组(n=22)和对照组(n=22)。瑞芬太尼组采用瑞芬太尼静脉自控分娩镇痛,硬膜外组行硬膜外分娩镇痛,对照组为自然分娩。记录3组产妇组产妇产程、出血量和新生儿体质量等一般情况指标,采用视觉模拟评分量表(VAS)评价产妇分娩各时点的疼痛指数,医院焦虑-抑郁情绪自评量表(HAD)评定产妇产前情绪状况,爱丁堡产后抑郁量表(EPDS)评价产妇产后抑郁状态,并对3组调查资料进行对比分析。 结果 瑞芬太尼组、硬膜外组和对照组患者年龄、体质量指数、孕周、产程、出血量和新生儿体质量等资料的差异无统计学意义(P>0.05)。3组产妇娩出后的VAS评分较分娩时均有所降低。瑞芬太尼组和硬膜外组分娩时、娩出后的VAS评分均比对照组低(P<0.05)。与硬膜外比较,瑞芬太尼组分娩时、娩出后的VAS评分稍高,差异有统计学意义(P<0.05)。3组产妇生产前的HAD评分及产前抑郁率差异无统计学意义(P>0.05)。生产后瑞芬太尼组EPDS评分和产后抑郁发生率低于对照组和硬膜外组(P<0.05)。对照组和硬膜外组EPDS评分差异无统计学意义(P>0.05)。硬膜外组产后抑郁发生率低于对照组(P<0.05)。 结论 瑞芬太尼静脉自控分娩镇痛较硬膜外镇痛效果差,但可以减少产妇产后抑郁现象的发生,对产前有抑郁倾向的产妇可选用瑞芬太尼静脉镇痛。 Abstract:Objective To study the impact of remifentanil intravenous patient-controlled intravenous analgesia on maternal postpartum depression. Methods 66 full-term primiparas with single head position delivery admitted in the department of obstetrics and gynecology of our hospital during March 2014-March 2017 were included. These cases were divided into remifentanil group (n=22), epidural group (n=22) and control group (n=22) by means of random number table. The remifentanil group were administered intravenous self-controlled analgesia with remifentanil, the epidural group epidural analgesia, while the control group had natural delivery. The general indicators of three groups, including maternal labor, blood loss and neonatal weight, were recorded. The pain index at each time point of delivery was evaluated by visual analogue scale (VAS), the hospital anxiety and depression questionnaire (HAD) was used to assess the prenatal emotional status of these cases and the Edinburgh Postnatal Depression Scale (EPDS) was applied to investigate their postpartum depression. The investigation date of three groups were comparatively analyzed. Results The remifentanil group, epidural group and control group had no significant differences in age, BMI, gestational age, birth course, blood loss and newborn weight (P> 0.05), and the VAS score of both groups after delivery was lower than that at delivery. The VAS score of remifentanil group and epidural group at and after delivery were lower than that of the control group (P<0.05). Compared with epidural group, the VAS score of remifentanil group after delivery was slightly higher with statistically significant results (P<0.05). There were no significant differences in HAD scores and prenatal depression between three groups(P> 0.05). The EPDS score and the incidence of postpartum depression in remifentanil group after delivery were significantly lower than those of control group and epidural group (P<0.05). There was no significant difference in EPDS scores between control group and epidural group(P> 0.05). The incidence of postpartum depression in the epidural group was lower than that of the control group (P<0.05). Conclusion Although the analgesic effect of remifentanil intravenous patient-controlled labor analgesia is poorer than epidural analgesia, it can significantly reduce the occurrence of postpartum depression, thus worthy of administration on pregnant women with prenatal depression tendency. -
Key words:
- remifentanil /
- labor analgesia /
- postpartum depression
-
表 1 一般相关资料比较(Mean±SD)
组别 年龄(岁) BMI(kg/m2) 孕周(周) 产程(min) 出血量(mL) 新生儿体质量(kg) 瑞芬太尼组 26.88±4.95 23.21±3.22 39.12±1.4 623.11±123.43 275.32±78.48 3.36±0.44 硬膜外组 27.20±5.12 23.15±3.11 38.78±1.3 627±126.32 272.86±74.53 3.38±0.41 对照组 27.34±5.22 23.34±3.29 38.64±1.3 631±130.48 278.32±79.12 3.40±0.43 BMI: 体质量指数; 3组比较, P>0.05. 表 2 3组产妇VAS评分比较(Mean±SD)
组别 分娩时 娩出后 瑞芬太尼组 3.47±1.02*# 1.64±0.76*# 硬膜外组 2.10±0.96* 1.57±0.81* 对照组 9.25±0.83 7.64±0.62 *P<0.05vs对照组; #P<0.05vs硬膜外组. 表 3 生产前后抑郁评分情况(分,Mean±SD)
组别 HAD EPDS 瑞芬太尼组 6.32±1.17 9.7±1.24* 硬膜外组 6.28±1.09 16.3±2.21 对照组 6.45±1.13 17.8±2.71 HAD: 医院焦虑-抑郁情绪自评量表; EPDS: 爱丁堡产后抑郁量表; *P<0.05vs对照组. 表 4 生产前后抑郁率比较(n,%)
组别 HAD EPDS 瑞芬太尼组 2(9.09) 1(4.55)*# 硬膜外组 1(4.55) 4(18.18)* 对照组 1(4.55) 8(36.36) HAD: 医院焦虑-抑郁情绪自评量表; EPDS: 爱丁堡产后抑郁量表; *P<0.05vs对照组; #P<0.05vs硬膜外组. -
[1] 张 巍, 安力彬, 刘 媛. 产后抑郁研究进展[J]. 中国妇幼保健, 2011, 26(14): 2227-9. [2] 李振菊, 刘相英, 刘 勇. 产后抑郁症[J]. 中国当代医药, 2010, 17(1): 168-9. [3] 崔月昕, 申 薇, 史 丽, 等. 导乐镇痛仪联合分娩球对初产妇分娩结局及产后抑郁的影响[J]. 河北医科大学学报, 2017, 38(7): 789-92. [4] 季 平, 邹雪梅, 徐文娟, 等. 无创分娩镇痛对顺产初产妇分娩镇痛及产后抑郁发生的影响[J]. 现代临床护理, 2015, 14(9): 37-40. [5] Hosseini F, Khalili M, Kamali A, et al. Effect of remifentanil on hemodynamic parameters of parturients and APGAR of the neonate in elective cesarean section under general anesthesia[J]. Cancer Lett, 2012, 206(2): 193-9. [6] 杨 勇, 冯秀娟, 陶晓敏, 等. 产后抑郁病因及发病机制研究进展[J]. 临床心身疾病杂志, 2012, 18(5): 419-21. [7] 张 妍, 张文颖, 周 玲, 等. 产后抑郁症的相关危险因素的探讨[J]. 中国实验诊断学, 2013, 17(1): 85-7. [8] Savitz DA, Stein CR, Ye F, et al. The epidemiology of hospitalized postpartum depression in New York state, 1995-2004[J]. Ann Epidemiol, 2011, 21(6): 399-406. [9] 苏 跃, 孙 杰, 徐铭军, 等. 分娩镇痛对产后抑郁症发生的影响[J]. 中华麻醉学杂志, 2015, 35(3): 317-9. [10] 李道兵, 秦 红, 刘海民. 不同剂量瑞芬太尼在分娩镇痛中的效果比较[J]. 实用临床医学, 2013, 14(5): 36-8. [11] 刘 辉. 瑞芬太尼在分娩镇痛中的应用进展[J]. 中国临床研究, 2010, 23(10): 928-30. [12] de Hoogd S, Ahlers SJ, van Dongen EP, et al. Is intraoperative remifentanil associated with acute or chronic postoperative pain after prolonged surgery? an update of the literature[J]. Clin J Pain, 2016, 32(8): 726-35. [13] de Hoogd S, Ahlers SJGM, van Dongen EPA, et al. Randomized controlled trial on the influence of intraoperative remifentanil versus fentanyl on acute and chronic pain after cardiac surgery[J]. Pain Pract, 2018, 18(4): 443-51. [14] Gaudet C, Wen SW, Walker MC. Chronic perinatal pain as a risk factor for postpartum depression symptoms in Canadian women[J]. Canadian J Public Health, 2013, 104(5): 375-87. [15] Davey HL, Tough SC, Adair CE, et al. Risk factors for sub-clinical and major postpartum depression among a community cohort of Canadian women[J]. Maternal&Child Health J 2011, 15(7): 866-75. [16] Goker A, Yanikkerem E, Demet MM, et al. Postpartum depression: is mode of delivery a risk factor[J]. Obstet Gynecol, 2012, 15(3): 616759-65. [17] Xie RH, Liao S, Xie H, et al. Infant sex, family support and postpartum depression in a Chinese cohort[J]. J Epidemiol Commun Health, 2011, 65(8): 722-6. [18] Pocan AG, Aki OE, Parlakgumus AH, et al. The incidence of and risk factors for postpartum depression at an urban maternity clinic in Turkey[J]. Int J Psychiatry Med, 2013, 46(2): 179-94. [19] 陈 红, 刘 建. 产后抑郁症的影响因素及防治进展[J]. 重庆医学, 2009, 38(6): 655-6. [20] 李 兵, 王燕琼, 苏 纲, 等. 瑞芬太尼静脉自控镇痛与罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛的比较[J]. 临床麻醉学杂志, 2012, 28(8): 781-3. [21] Beydoun HA, Al-Sahab B, Beydoun MA, et al. Intimate partner violence as a risk factor for postpartum depression among Canadian women in the maternity experience survey[J]. Ann Epidemiol, 2010, 19(3): 606-7. [22] Mori T, Tsuchiya KJ, Matsumoto K, et al. Psychosocial risk factors for postpartum depression and their relation to timing of onset: The Hamamatsu Birth Cohort (HBC) Study[J]. J Affect Disord, 2011, 135(1/3): 341-6. [23] Kranke P, Girard T, Lavand P, et al. Must we press on until a young mother dies? Remifentanil patient controlled analgesia in Labour May not be suited as a"poor man's epidural[J]. BMC Pregnancy Childbirth, 2013, 13(1): 1-8.
计量
- 文章访问数: 888
- HTML全文浏览量: 270
- PDF下载量: 6
- 被引次数: 0