用系统思想探讨硬膜外阻滞分娩镇痛对产后抑郁症的影响  

USE SYSTEMS THINKING TO STUDY THE EFFECT OF EPIDURAL BLOCK ANESTHESIA OF LABOR ON PUERPERAL DEPRESSION

作　　者：尹春艳[1] 张智[1] 陈健飞[1] 李泽泳[1] 陈月秀[2] 刘婷婷 陈晓艳 

机构地区：[1]广东省第二人民医院,广东广州510317 [2]广州新海医院,广东广州510300 [3]广州市海珠区新窖人民医院,广东广州510321 [4]广州市天河区红会医院,广东广州514023

出　　处：《现代医院》2006年第11期12-15,共4页Modern Hospitals

基　　金：广东省医学科研基金资助课题(A2004518);广东省自然基金资助项目(040005053)

摘　　要：目的用系统思想探讨硬膜外阻滞分娩镇痛对产后抑郁症相关因素的影响。方法2005年8月-11月广东省第二人民医院采用硬膜外阻滞分娩镇痛并阴道分娩的初产妇121例为研究组，同期未采取任何分娩镇痛技术的广州市内其他3家医院阴道分娩的初产妇97例为对照组，两组第1产程末进行焦虑自评量表（SAS）评分，第3产程末和产后7d抽肘静脉血进行雌二醇（E2）、孕酮（P）、催乳素（PRL）检测，产后3d和产后7d分别进行EPDS评分。结果两组间比较：第1产程末SAS评分比较对照组明显高于研究组，有显著性差异（P〈0．001）；第3产程末和产后7dE2、P均有显著性差异（P〈0．05—0．001），研究组E2、P明显高于对照组；PRL无显著性差异（P〉0．05）。两组组内比较：不同时间段E2、P均有显著性差异（P〈0．001），PRL值无显著性差异（P〉0．05）。研究组产后3d、7dEPDS评分和产后抑郁症发生率比较明显低于对照组（P〈0．02～0.05）。结论硬膜外阻滞分娩镇痛是降低产后抑郁症的生物一心理一社会学效应，减少产后抑郁症发病率的重要途径之一。Objective Using systems thinking to explore the influence of epidural block anesthesia of labor on the correlative factors of puerperal depression. Methods 121 primipara of spontaneous labor who accepted epidural block anesthesia of labor in The Second People＇s Hospital of Guangdong Province from August, 2005 to November, 2005 were chosen as the experimental group, 97 parturient of spontaneous labor who did not accept any anesthesia of labor in other three hospitals in Guangzhou city at the same time as the control group. Made SAS scores at the end of the first stage of labor. Monitored the numerical value of E2, P, PRL at the end of the third stage of labor and the postpartum seventh day. Made EPDS scores on the postpartum third day and the postpartum seventh day. Results The SAS scores in the experimental group were significantly higher than those in the control group at the end of first stage of labor （p 〈0. 001）. At the end of third stage of labor and postpartum seventh day, there were significant differences in the levels of E2, P （p 〈 0.05 -0.01 ） between the two groups. The levels of E2 and P in the experimental group were significantly higher than those in the control group. There was no significant difference in the levels of PRL （p 〉0.05）. In the same group, there were significant differences in the levels of E2, P （p 〈0. 001 ） at the different time points ; while there was no significant difference in the levels of PRL （p 〉 0.05 ）. Scores of EPDS and the incidence of puerperal depression state in the experimental group were significantly lower than those in the control group （p 〈 0.02 - 0.05 ） . Conclusion Epidural block anesthesia oflabor can decrease the effect ofpuerperaldepression on the organism - psychology - sociology. Anesthesia of labor is one of the important ways to decrease the incidence of puerperal depression state.

关 键 词：系统思想 硬膜外阻滞 分娩镇痛 产后抑郁症 

分 类 号：R714.3[医药卫生—妇产科学]