右美托咪啶改善剖宫产术后的产后抑郁症状的研究：一项随机、安慰剂对照研究
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Dexmedetomidine Alleviates Postpartum Depressive Symptoms following Cesarean Section in Chinese Women: A Randomized, Placebo-Controlled Study
背景与目的
很少有研究去探索右美托咪定(DEX)对产后抑郁症状(PDS)的预防作用。采用随机、双盲、安慰剂对照的研究方法去研究在分娩后立即给予患者DEX或将其用于病人自控静脉镇痛(PCIA)是否能减轻PDS。
方 法
将600例在腰麻下择期剖宫产的病人随机分为对照组（输注0.9%生理盐水和舒芬太尼PCIA）和DEX组（分娩后以0.5ug/kg输注DEX及舒芬太尼自控静脉镇痛）。产后抑郁症的患病率参考爱丁堡产后抑郁量表。对产妇术后镇痛、镇静、睡眠质量进行评估。
结 果
右美托咪定组的产后抑郁和产后抑郁症状比对照组更低(5.0%vs14.1%，p<0.001；5.7%vs16.3%，p<0.001)，尤其是在孕期有产前抑郁或中度压力的产妇。与对照组相比，DEX组产后7d和42d的爱丁堡产后抑郁量表(EPDS)评分明显低于对照组(4.23 ±4.37vs1.93 ±3.36, p < 0.001, 4.68 ±4.78vs1.99 ±3.18, p < 0.001, 与对照组相比，DEX组产后7d和42d的产后自残意念发生率也是如此。(1.1% vs 4.0%, p=0.03; 0.4% vs 2.9%, p=0.04）。DEX组的睡眠质量和疼痛评分比对照组更好（P<0.01）
结 论
产后早期应用DEX可显著降低产后抑郁症的发生率。
原始文献摘要
He-Ya Yu,Sai-Ying Wang,Cheng-Xuan Quan. Dexmedetomidine Alleviates Postpartum Depressive Symptoms following Cesarean Section in Chinese Women: A Randomized, Placebo-Controlled Study.Pharmacotherapy. 2019 Aug 14. doi: 10.1002/phar.2320.
Objectives: Few studies have investigated the prophylactic efficacy of dexmedetomidine (DEX) in postpartum depressive symptoms (PDS). A randomized, double-blind, placebo-controlled trial was conducted to investigate whether the administration of DEX, immediately after delivery and for patient controlled intravenous analgesia (PCIA), can attenuate PDS.
Methods:Six hundred parturients scheduled for elective caesarean delivery under spinal anesthesia were randomly allocated into the Control group (infusion with 0.9%normal saline after delivery and PCIA with sufentanil) and the DEX group (DEX infusion 0.5ug.kg-1 after delivery and PCIA with DEX plus sufentanil).The prevalence of postpartum depressive disorders was indicated by the Edinburgh Postnatal Depression Scale. Postoperative analgesia, sedation, and sleep quality of parturients were also assessed.
Results: Postpartum blues and PDS prevalence in the DEX, versus Control, group was significantly lower (5.0%vs14.1%,p<0.001; 5.7%vs16.3%,p<0.001, respectively), especially in parturients with antenatal depression or moderate pressure during pregnancy. Compared with the Control group, the Edinburgh Postnatal Depression Scale (EPDS) score at postpartum 7d and 42d in the DEX group was significantly lower (4.23±4.37vs1.93±3.36,p<0.001; 4.68±4.78vs1.99±3.18, p<0.001, respectively), as was the incidence of postpartum self-harm ideation at postpartum 7d and 42d in the DEX group, versus the Control group (1.1% vs 4.0%, p=0.03; 0.4% vs 2.9%, p=0.04, respectively). The pain score and the sleep quality in the DEX group was better than that in the Control group (p<0.001).
Conclusion:The application of DEX in the early postpartum period can significantly attenuate the incidence of postpartum depressive disorders.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙