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小剂量右美托咪定辅助硬膜外分娩镇痛对初产妇分娩焦虑及产后抑郁的影响▲
Effects of low-dose dexmedetomidine-assisted epidural labor analgesia on labor anxiety and postpartum depression in primiparae

微创医学 页码:534-539

作者机构:广西壮族自治区人民医院麻醉科, 广西南宁市 530213

基金信息:广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z-A20230018) *通信作者

DOI:10.11864/j.issn.1673.2025.05.06

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目的 探讨小剂量右美托咪定辅助硬膜外分娩镇痛对初产妇分娩焦虑及产后抑郁的影响。方法 选取60例初产妇作为研究对象,将其随机分为对照组和观察组,每组30例。两组初产妇均经阴道分娩,并接受硬膜外分娩镇痛。其中观察组镇痛泵配方为0.1%罗哌卡因+0.3 μg/mL舒芬太尼+0.2 μg/mL右美托咪定,对照组镇痛泵配方为0.1%罗哌卡因+0.5 μg/mL舒芬太尼。于分娩镇痛前、分娩活跃期采用焦虑自评量表(SAS)评估两组初产妇的焦虑程度。于分娩镇痛前、产后42 d采用爱丁堡产后抑郁量表(EPDS)评估两组初产妇的抑郁程度。记录两组初产妇分娩镇痛前(T0)、分娩镇痛后30 min(T1)、分娩活跃期(T2)、分娩时(T3)、分娩后2 h(T4)的血压、心率、疼痛视觉模拟评分法(VAS)评分,以及不良反应发生情况。结果 分娩镇痛前,两组SAS评分差异无统计学意义(P>0.05),分娩活跃期,观察组SAS评分低于对照组(P<0.05);分娩镇痛前及产后42 d,两组EPDS评分差异无统计学意义(P>0.05);在T1、T2、T3、T4时间点,观察组疼痛VAS评分低于对照组(P<0.05);两组收缩压、舒张压水平,以及心率差异无统计学意义(P>0.05);两组头晕、呕吐、瘙痒、尿潴留发生率差异无统计学意义(P>0.05)。结论 小剂量右美托咪定辅助硬膜外分娩镇痛可以有效减轻初产妇分娩过程的疼痛,缓解焦虑情绪,且不增加相关不良反应。

Objective To explore the effects of low-dose dexmedetomidine-assisted epidural labor analgesia on labor anxiety and postpartum depression in primiparae. Methods A total of 60 primiparae were enrolled as the research subjects and randomly divided into a control group and an observation group, with 30 cases in each group. Both groups of primiparae underwent vaginal delivery and received epidural labor analgesia. Among them, the formula of analgesia pump in the observation group contained 0.1% ropivacaine + 0.3 μg/mL sufentanil + 0.2 μg/mL dexmedetomidine, while that in the control group contained 0.1% ropivacaine + 0.5 μg/mL sufentanil. The Self-Rating Anxiety Scale (SAS) was used to assess the severity of anxiety in both groups of primiparae before epidural labor analgesia and active phase of labor. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the severity of depression in both groups before epidural labor analgesia and at 42 days postpartum. Data on blood pressure, heart rate and Visual Analogue Scale (VAS) pain score were recorded in both groups of primiparae at the following time points: before epidural labor analgesia (T0), 30 minutes after epidural labor analgesia (T1), active phase of labor (T2), during delivery (T3), and 2 hours after delivery (T4). Additionally, the occurrence of adverse reaction was documented. Results Before epidural labor analgesia, there were no statistically significant differences in SAS scores between the two groups (P>0.05), whereas during the active phase of labor, SAS scores in the observation group were lower than those in the control group (P<0.05). There were no statistically significant differences in EPDS scores between the two groups before epidural labor analgesia and at 42 days postpartum (P>0.05). At time points T1, T2, T3, and T4, VAS pain scores in the observation group were lower than those in the control group (P<0.05). Meanwhile, there were no statistically significant differences in levels of blood pressure, diastolic blood pressure and heart rate between the two groups (P>0.05). Additionally, the incidence of adverse reactions including dizziness, vomiting, pruritus and urinary retention showed no statistically significant difference between the two groups (P>0.05). Conclusion Low-dose dexmedetomidine-assisted epidural labor analgesia can effectively alleviate pain during delivery, mitigate anxiety, and does not increase the incidence of relevant adverse reactions.

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