脑状态焦虑指数评估围产期产妇焦虑障碍  

Application of brain status anxiety index for assessing perinatal maternal anxiety disorders

作　　者：李胜华[1] 夏建华 罗威[1] 张芸 赵继蓉[1] 张丽峰 陆勤[2] 夏一梦[4] 罗艳[4] LI Shenghua;XIA Jianhua;LUO Wei;ZHANG Yun;ZHAO Jirong;ZHANG Lifeng;LU Qin;XIA Yimeng;LUO Yan(Department of Anesthesiology,Jiading Maternal and Child Health Hospital,Shanghai 201821,China)

机构地区：[1]上海市嘉定区妇幼保健院麻醉科,上海201821 [2]上海市嘉定区妇幼保健院产科,上海201821 [3]上海市浦东新区人民医院麻醉科 [4]上海交通大学医学院附属瑞金医院麻醉科

出　　处：《上海医学》2024年第8期489-493,共5页Shanghai Medical Journal

基　　金：上海市嘉定区卫生健康委员会科研立项(2020-KY-01);上海市浦东新区卫生健康委员会卫生科技项目(PW2020A-26)。

摘　　要：目的探讨脑状态焦虑指数(ANXi)评估围产期产妇焦虑障碍的可行性。方法选择2022年5—12月在上海市嘉定区妇幼保健院拟行经阴道分娩的初产妇384例,按照产妇意愿分为3组:不接受硬膜外分娩镇痛的产妇可选择导乐分娩(无镇痛组),接受硬膜外分娩镇痛的产妇随机分入潜伏期镇痛组(潜伏期开始硬膜外镇痛)、活跃期镇痛组(活跃期开始硬膜外镇痛),每组128例。比较产妇的一般资料(年龄、BMI、孕周、产程时间和新生儿出生后1、5 min时的Apgar评分),以及孕晚期、分娩期间、产后6周的7项广泛性焦虑自评量表(GAD-7)评分、ANXi、GAD-7评分≥10分患者比例。采用Pearson相关性分析分娩前ANXi与GAD-7评分是否存在线性相关,并进一步分析ANXi与控制不同混杂因素(围产期不同阶段、是否接受硬膜外镇痛、有无焦虑障碍)GAD-7评分的相关性;绘制ROC曲线检测ANXi评估焦虑障碍(GAD-7评分≥10分)的能力。结果330例产妇完成研究,其中潜伏期镇痛组112例、活跃期镇痛组113例、无镇痛组105例,3组产妇的年龄、BMI、孕周、产程时间和新生儿出生后1、5 min时的Apgar评分,以及孕晚期、分娩期间、产后6周GAD-7评分、ANXi、GAD-7≥10分患者比例的差异均无统计学意义(P值均>0.05)。Pearson相关性分析结果显示,产妇ANXi与GAD-7评分呈正相关(r=0.779,P<0.0001);孕晚期(r=0.794)、分娩期间(r=0.778)、产后6周(r=0.776)、潜伏期镇痛(r=0.693)、活跃期镇痛(r=0.871)、无硬膜外镇痛(r=0.828)、有焦虑障碍(r=0.697)、无焦虑障碍(r=0.641)产妇的ANXi与GAD-7评分间均具有相关性(P值均<0.001)。根据ANXi构建的ROC曲线的AUC为0.867,ANXi诊断围产期产妇焦虑障碍的最佳临界值为14.5,其诊断灵敏度、特异度和Youden指数分别为0.800、0.883、0.683。结论基于脑电小波算法的ANXi可用于评估产妇的焦虑障碍及其程度。Objective To explore the feasibility of the anxiety index in assessment of anxiety disorders in peripartum women.Methods A total of 384 primiparous women who intended to undergo vaginal delivery at the Jiading Maternal and Child Health Hospital in Shanghai between May and December 2022 were included.The participants were divided into three groups based on their preferences,with 128 in each group.Women who opted for epidural labor analgesia were randomly assigned to group LP(starting epidural analgesia in the latent phase)or group AP(starting epidural analgesia in the active phase),and those who declined epidural labor analgesia(doula could be used when needed)were assigned into group NA.The characteristic data(age,body mass index,gestational weeks,labor duration,and Apgar scores at 1 and 5 minutes),and 7-item Generalized Anxiety Disorder Scale(GAD-7)score,anxiety index and the proportion of women with GAD-7 score≥10 at the third trimester of pregnancy,during delivery,and at 6 weeks after delivery were recorded.Pearson correlation analysis was performed to evaluatethe linear relationship between antepartum anxiety indexand GAD-7 scores and re-evaluate the correlation after controlling confounding factors(different stages of the perinatal period,whether epidural analgesia was received,presence or absence of anxiety).Receiver operating characteristic(ROC)curves were used to assess the diagnostic ability of anxiety indexfor perinatal anxiety(defined as GAD-7 score≥10).Results A total of 330 women were included for final analysis,with 112 in the group LP,113 in the group AP,and 105 in the group NA.There were no significant differences among the three groups in the age,BMI,gestational weeks,labor duration,Apgar scores at 1 and 5 minutes,GAD-7 score,anxiety index or the proportion of women with GAD-7 score≥10 at any time points assessed(all P>0.05).Pearson correlation analysis revealed a positive correlation between anxiety index and GAD-7 scores(r=0.779,P<0.0001);a good correlation was found between different sub

关 键 词：焦虑指数 脑电图 7项广泛性焦虑自评量表 焦虑障碍 分娩镇痛 

分 类 号：R443[医药卫生—诊断学]