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Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study
背景与目的
重度分娩疼痛是产后抑郁的重要危险因素，其与早期抑郁与长期抑郁风险增加相关；而分娩期间使用硬膜外镇痛是否可降低产后抑郁风险，目前尚未有完整研究报道；本研究探讨分娩镇痛与产后两年产妇抑郁风险降低是否相关。
方 法
本研究为多中心、前瞻性、纵向试验，本研究于2014年8月1日至2017年4月25日在北京大学第一医院、北京妇产科医院和中国北京海淀妇幼保健院进行，共纳入599例初产妇进行单胎妊娠准备阴道分娩的产妇。主要指标：接受椎管内镇痛的产妇于镇痛前、镇痛后10 min及30 min、宫口开全时采用NRS进行疼痛评分；未接受椎管内镇痛的产妇于宫口开至1 cm以上及宫口开全时进行疼痛评分。产后1d（20~26 h）进行第一次随访，记录喂养方式和NRS评分等。产后6周（42~49 d）进行电话随访，用EPDS评估产后抑郁情况，10分及以上定义为产后抑郁的界值。产后2年（23~24个月）进行面对面随访，记录EPDS评分、SSRS评分及其他母亲及小儿相关数据。主要研究指标为产后2年是否存在抑郁。
结 果
最终有508例产妇完成全部随访并纳入分析，其中368例（72.4%）接受了椎管内分娩镇痛。产后2年9.1% （46/508）的产妇患有抑郁，其中2.8%（14/508）在产后6周和2年均表现出抑郁症状。对混杂因素调整后发现，采用椎管内分娩镇痛与降低产后2年抑郁症风险显著相关(OR 0.455, 95% CI 0.230 - 0.898, P=0.023)。
结 论
对于单胎头位妊娠计划用于阴道分娩的产妇，分娩期间行分娩镇痛与产妇2年内抑郁发生风险降低有关。
原始文献摘要
Liu ZH, He ST, Deng CM,et al;Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study. 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.To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression.
Method:This was a multicentre, prospective, longitudinal study. 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.Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled. 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.
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翻译：王贵龙 编辑：何幼芹 审校：王贵龙
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