【摘要】 目的 探究镇痛分娩对潮汕地区初产妇产程时间、分娩结局、产后抑郁风险的影响，分析可能影响产后抑郁的因素，并对爱丁堡产后抑郁量表的优化进行探究。方法 采用回顾性分析法选择2018—2019年在本院分娩的潮汕地区初产妇180例为研究对象，分为实验组和对照组两组，每组各90例。实验组进行镇痛分娩，对照组进行非镇痛分娩组。选用一般情况调查表、抑郁自评量表(SDS)和爱丁堡产后抑郁量表(EPDS)对180例初产妇进行心理评估；观察比较两组产妇产程时间、宫缩乏力情况、产时产后出血量(产后2小时)、新生儿Apgar评分。结果 两组产前SDS评分比较，差异无统计学意义(P>0.05)。实验组的总产程时间、第一产程时间、第二产程时间均长于对照组(P<0.05),第三产程时间两组比较差异无统计学意义(P>0.05);实验组在第一产程宫缩乏力的发生率高于对照组，差异有统计学意义(P<0.05)。实验组和对照组在产时产后出血量(产后2小时)、新生儿Apgar评分上差异无统计学意义(P>0.05)。实验组产后一周和产后六周的EPDS评分低于对照组，差异有统计学意义(P<0.05)。产后一周以9分作为抑郁分界值的χ~2检验结果与t检验结果相似，差异有统计学意义(P<0.05);以13分作为分界值的χ~2检验结果显示差异无统计学意义(P>0.05)。产后6周以9分作为分界值的χ~2检验结果与t检验结果相似，差异有统计学意义(P<0.05);以13分作为分界值的χ~2检验与t检验结果相似，差异有统计学意义(P<0.05)。实验组产后一周EPDS评分与产后6周相比，差异无统计学意义(P>0.05);对照组产后6周EPDS评分高于产后一周，差异有统计学意义(P<0.05)。结论 镇痛分娩使总产程时间、第一产程时间、第二产程时间较长，但均在正常范围内，对第三产程时间无影响；镇痛分娩增加了第一产程中宫缩乏力的发生率，但对总产程时间、产时产后出血量(产后2小时)及新生儿Apgar评分无影响。此外，镇痛分娩既能降低产后抑郁发生的风险，又能减缓抑郁倾向的发展，有利于产妇产后的心理健康。产后一周的EPDS分界值9分优于13分，产后6周以9分或13分作为分界值结果无差异。更多还原

【Abstract】 Objective To explore the effect of analgesic delivery on stage of labor, delivery outcome, postpartum depression risk of primiparas in Chaoshan area, analyze the factors that may affect postpartum depression,and explore the optimization of Edinburgh Postpartum Depression Scale. Methods Retrospective analysis was applied to select 180 primiparasfrom Chaoshan area who delivered in our hospital during 2018 and2019 as the research objects.They were divided into experimental group and control group,90 cases in each group.Primiparas in the experimental group were given analgesic delivery,while non-analgesic deliverywas applied in the control group.The 180 primiparas received psychologicalassessed by using general situation questionnaire,self-rating Depression Scale( SDS) and Edinburgh Postpartum Depression Scale( EPDS). The delivery duration,occurrence of uterine inertia,amount of intrapartum and postpartum hemorrhage( two hours after delivery),neonatal Apgar score were observed and compared between the two groups.The data were analyzed by SPSS 20.0.Descriptive statistical analysis,independent sample T test,paired sample T test and chi-square test were used to analyze the data.Results The results showed that there was no statistically significant difference in the general data between the two groups( P>0.05).There was no significant difference in prenatal SDS score( P> 0.05). The total labor time,the first labor time,and the second labor time of the experimental group were longer than those of the control group( P < 0. 05),and there was no significant difference in the third stage of labor between the two groups( P>0.05).The incidence of uterine weakness in the experimental group was higher than that in the control group,and the difference was statistically significant( P < 0. 05). There were no significant difference between the experimental group and the control group in amount of intrapartum and postpartum hemorrhage( two hours after delivery),and Apgar score( P > 0. 05). EPDS score of the experimental group was lower than that of the control group at 1 week postpartum and 6 weeks postpartum,and the difference was statistically significant( P<0.05).The result of the chi-square test with 9 points as the depression threshold at one week after delivery was similar to the result of the T test,and the difference was statistically significant( P<0.05).The chi-square test with 13 points as the cut-off showed no statistically significant difference( P>0.05). The result of chi-square test with 9 points as the threshold at 6 weeks postpartum was similar to the result of T test,and the difference was statistically significant( P<0.05).The result of the chi-square test with 13 points as the cut-off value was similar to the result of the T test,and the difference was statistically significant( P<0.05).There was no statistical significance between the EPDS score at one week after delivery andat six weeks after delivery in the experimental group( P>0.05). The EPDS score of the control group at 6 weeks postpartum was higher than that at 1 week postpartum,and the difference was statistically significant( P < 0. 05). Conclusions Analgesia induced longer total labor time,first labor time,and second labor time which wereall within the normal range,however,had no effect on the third labor time.Analgesic delivery increases the incidence of uterine weakness in the first stage of labor,but had no effect on the total duration of labor,postpartum blood loss( 2 hours postpartum) and Apgar score of the newborn.In addition,analgesic delivery could not only reduce the risk of postpartum depression,but also slow down the development of depression tendency,which was beneficial to postpartum mental health of puerpera. The EPDS threshold of 9pointsat 1 week postpartum was better than 13 points,and there was no difference at 6 weeks postpartum with 9points or 13 points as the threshold.更多还原