分娩镇痛法可作为减少产后抑郁症评分的预测指标：一项回顾性观察研究
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Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study
背景与目的
使用分娩（硬膜外）镇痛法可以降低产后抑郁症的风险，但减轻产后疼痛与减少产后抑郁症的联系仍不明确。本研究的目的是验证这种假设——在分娩时有效的硬膜外镇痛与减少产后抑郁症的症状有关。
方 法
选择一个单一的、由来已久的、回顾性的、观察性的类似群体设计。最主要的指标是爱丁堡产后抑郁量表(EPDS)评分，以6周的产后访视为衡量标准。最终分析的受试者为(1)接受了硬膜外麻醉;（2）分娩前和分娩期间的疼痛评估，以0-10的数字进行评分;(3)由EPDS评估的抑郁风险，并记录了其6周的产后访问。使用单一和多元线性回归来确定最好的模型以评估疼痛改善之间的关系,即定义为排除了焦虑病史和抑郁病史以及其他精神病史，成瘾，创伤，分娩方式，其他产妇胎儿共病的疾病后的疼痛改善百分比(PIP)和抑郁症。
结 果
最终的结果中包二百零一名患者。女性患者较好的疼痛改善效果与其较低的EPDs分数相关（r=0.025;P = .002)。与抑郁症相关的变量（身高体重指数、焦虑和/或抑郁、三、四度的会阴撕裂和贫血）与EPDS评分密切相关，并纳入最终模型。在我们调整了这些协变量之后，PIP仍然是EPDS分数的一个重要预测因子（r=0.49;P=.008），占产后抑郁分值变化的6.6%。包含疼痛，身高体重指数，焦虑和/或抑郁，会阴撕裂和贫血的完整模型解释了24%的产后抑郁评分的变化。
结 论
尽管无痛分娩镇痛法的止痛效果可以预测较低的产后抑郁评分，但与其他已确定的抑郁风险因素相比，PIP对产后抑郁症状的相对贡献可能更少。这些数据支持在产后抑郁症的发展过程中，需要更清楚地说明分娩镇痛的临床意义。
原始文献摘要
Lim G, Farrell L M, Facco F L, et al. Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study.[J]. Anesthesia & Analgesia, 2017:1.
BACKGROUND: Using labor, epidural analgesia has been linked to a reduced risk of postpartum depression, but the role of labor pain relief in this association remains unclear. The goal of this study was to test the hypothesis that effective epidural analgesia during labor is associated with reduced postpartum depression symptomatology.
METHODS: A single, institutional, retrospective, observational cohort design was chosen. The primary outcome was Edinburgh postnatal depression scale (EPDS) score, measured at the 6-week postpartum visit. Subjects included in the final analysis had (1) received labor epidural analgesia; (2) pain assessed during labor both before and during initiation of labor epidural analgesia by 0–10 numeric rating scores; and (3) depression risk assessed by the EPDS and documented at their 6-week postpartum visit. Simple and multiple linear regression was used to identify the best model for assessing the association between pain improvement, defined as percent improvement in pain (PIP), and depression, after adjusting for a history of anxiety or depression, other psychiatric history, abuse, trauma, mode of delivery, and other maternal or fetal comorbid diseases.
RESULTS: Two hundred one patients were included in the final analysis. Women with higher improvements in pain were associated with lower EPDS scores (r = 0.025; P = .002). Variables known to be associated with depression (body mass index, anxiety and/or depression, thirdand fourth-degree perineal lacerations, and anemia) were significantly correlated with EPDS score and included in the final model. After we adjusted for these covariates, PIP remained a significant predictor of EPDS score (r = 0.49; P = .008), accounting for 6.6% of the variability in postpartum depression scores. The full model including pain, body mass index, anxiety and/ or depression, perineal lacerations, and anemia explained 24% of the variability in postpartum depression scores.
CONCLUSIONS: Although the extent of labor pain relief by epidural analgesia predicts lower postpartum depression scores, the relative contribution of PIP to risk for postpartum depression symptoms may be less than other established risk factors for depression. These data support that the clinical significance of labor analgesia in the development of postpartum depression needs to be more clearly defined
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