国际麻醉学与复苏杂志   2025, Issue (6): 0-0
    
产前焦虑对择期剖宫产产妇产后抑郁的影响
郭珊珊, 党静静, 盛婧祎, 王蕊, 王志萍1()
1.徐州医科大学麻醉学院
Effect of prenatal anxiety on postpartum depression in women undergoing elective cesarean section
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摘要：

目的 探讨产前焦虑对择期剖宫产产妇产后3个月时产后抑郁（postpartumdepression, PPD）发生的影响。方法 本项前瞻性队列研究共纳入145例拟行择期剖宫产的产妇。术前采用状态特质焦虑量表中的状态子量表（State subscale in State-trait Anxiety Inventory, STAI-S）检测母亲产前焦虑情况，分数40分纳入为产前焦虑组，≤40分纳入非产前焦虑组。收集产妇的人口统计学数据、产科特征、心理学特征、血浆及脑脊液中生化指标、术中及产后指标等。产后3个月采用爱丁堡产后抑郁量表（Edinburgh Postpartum Depression Scale，EPDS） 和患者健康问卷-9（Patient Health Questionnaire-9，PHQ-9）评估抑郁情况。结果 在择期剖宫产产妇中，与非产前焦虑组相比，产前焦虑组产后3个月PPD的发生率显著升高（65.2%VS15.2%，P0.001），产前焦虑对产后三个月抑郁的相对危险度（Relative Risk，RR）为4.304（95%CI：2.580~7.180）。采用多因素Logistic回归校正两组间的混杂因素后，发现产前焦虑仍然与PPD存在显著相关性，是产后抑郁的强预测因素（调整OR=7.618，95%CI：1.880~30.865，P=0.004）。多因素Logistic回归显示较高的STAI-S评分（调整OR值：1.221，95%CI:1.095~1.362）、较高的EPDS评分（调整OR值:1.362，95%CI:1.144~1.622）、较长的孕周（调整OR值：2.661，95%CI:1.336~5.302）是产后抑郁的危险因素，而高水平的脑脊液缩宫素水平（调整OR:0.851，95%CI:0.716~0.950）、新生儿正常出生体重（调整OR:0.017，95%CI:0.001~0.344）、高社会支持评定量表（Social Support Rating Scale, SSRS）得分（调整OR:0.882，95%CI:0.794~0.980）是产后抑郁的保护因素。结论 产前焦虑预示着择期剖宫产产妇产后3个月PPD的发生，同时，产前高水平的焦虑、抑郁及较长的孕周是产后抑郁的危险因素，而脑脊液中高缩宫素水平、高社会支持度及新生儿正常出生体重是产后抑郁的保护因素。
关键词： 产前焦虑；产后抑郁；剖宫产；缩宫素；
Abstract:

Objective To examine the effect of prenatal anxiety on postpartum depression(PPD) at 3 months postpartum in women with elective cesarean section. Methods This prospective cohort study inclued 145 women undergoing elective cesarean section. The State subscale in State-trait Anxiety Inventory (STAI-S) was used to detect the prenatal anxiety in mothers. Score40 points were divided into prenatal anxiety group, score≤40 points were divided into non prenatal anxiety group.The demographic data, obstetric characteristics, psychological characteristics, biochemical indexes in plasma and cerebrospinal fluid, intraoperative and postpartum indexes were collected.The Edinburgh Postpartum Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) was used to assess PPD at 3 months postpartum. Result In women with elective cesarean section，compared with non prenatal anxiety group, the incidence of PPD at 3 months postpartum in the prenatal anxiety group was significantly higher (65.2%VS15.2%, P0.001), the Relative Risk (RR) of prenatal anxiety was 4.304 (95%CI：2.580~7.180, P0.001). After adjusting for the confounding factors between the two groups, multivariate Logistic regression analysis showed that prenatal anxiety was still significantly correlated with PPD and was a strong predictor of PPD (adjusted OR=7.618, 95%CI: 1.880~30.865, P=0.004). Multivariate Logistic regression analysis showed that prenatal anxiety STAI-S score (adjusted OR: 1.221, 95%CI:1.095~1.362), prenatal depression EPDS score (adjusted OR: 1.362, 95%CI:1.144~1.622), longer gestational weeks(adjusted OR: 2.661, 95%CI:1.336~5.302) were risk factors for PPD. High cerebrospinal fluid oxytocin levels (adjusted OR:0.851, 95%CI:0.716~0.950), normal birth weight (adjusted OR:0.017, 95%CI:0.001~0.344), high Social Support Rating Scale（SSRS）scores (adjusted OR:0.882, 95%CI:0.794~0.980) were protective factors for PPD. Conclusion Prenatal anxiety predicts PPD at 3 months after cesarean section. At the same time, high levels of prenatal anxiety, depression and long gestational weeks are risk factors for PPD, while high levels of cerebrospinal fluid oxytocin, high social support and normal birth weight of newborns are protective factors for PPD.
Key words: Prenatal anxiety; Postpartum depression; Cesarean delivery; Oxytocin