Abstract:

Objective　To explore the effect of parecoxib on Edinburgh depression scores, postpartum depression, and blood levels of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine (5-HT) of puerperants who receive analgesia with single epidural morphine injection combined with dezocine intravenous analgesia after cesarean section. Methods　Eighty full-term pregnant women treated at Department of Obstetrics, Foshan Second People's Hospital from January 2022 to December 2022 were recruited. Their American Society of Anesthesiologists (ASA) grade was Ⅰ-Ⅱ; they were 20-39 years old; their body weight was 50-80 kg; they were 37-41 weeks pregnant. They were divided into a control group and an observation group by the random number table method, with 40 cases in each group. They planned to take selective cesarean section. The single epidural morphine injection combined with intravenous analgesia with dezocine was used in both groups; parecoxib was added in the above analgesic methods in the observation group. The postoperative pain scores [Visual Analogue Scale (VAS)] and analgesic adverse reactions were observed. The maternal Edinburgh Postnatal Depression Scale (EPDS) score was evaluated 1 day before and 3 days and 2 weeks after cesarean section. The incidence of postpartum depression was recorded. The serum levels of BDNF and 5-HT were measured by the enzyme-linked immunization. One-way ANOVA and χ² test were used for the statistical analysis. Results　The scores of VAS 12, 24, and 48 h after delivery in the observation group were lower than those in the control group [(2.23±0.83) vs. (3.05±0.82), (2.98±0.86) vs. (3.78±1.03), and (3.43±0.87) vs. (3.90±0.96)], with statistical differences (all P<0.05). There was no statistical difference in the overall incidence of adverse reactions during the analgesia between the two groups (P>0.05). The scores of EPDS 3 days and 2 weeks after delivery in the observation group were lower than those in the control group [(7.23±2.55) vs. (9.55±3.52) and (8.15±3.09) vs. (9.58±2.78)], with statistical differences (both P<0.05). The incidences of postpartum depression in the observation group 3 days and 2 weeks after delivery were lower than those in the control group [7.50% (3/40) vs. 25.00% (10/40) and 5.00% (2/40) vs. 22.50% (9/40)], with statistical differences (both P<0.05). The serum levels of BDNF and 5-HT 3 days and 2 weeks after delivery in the observation group were higher than those in the control group, with statistical differences (all P<0.05). Conclusion　Parecoxib can enhance the analgesia effect of epidural morphine combined with dezocine intravenous analgesia, reduce the EPDS score and the incidence of postpartum depression after cesarean section, and increase the serum levels of BDNF and 5-HT without increasing adverse reactions.

Key words:

Caesarean section, Postpartum depression, Parecoxib, Multimodal analgesia

摘要：

探讨帕瑞昔布钠对行硬膜外吗啡联合地佐辛静脉镇痛术的剖宫产产妇产后爱丁堡抑郁评分、产后抑郁症及血清脑源性神经营养因子、5-羟色胺（5-HT）水平的影响。方法　本研究采用前瞻性研究。招募80例2022年1月至12月在佛山市第二人民医院产科收治的足月孕产妇，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，年龄20～39岁，体质量50～80 kg，孕周37～41周。计划择期行剖宫产手术，按照随机数字法将产妇分为对照组和观察组，每组40例。两组产后均采用硬膜外吗啡联合地佐辛静脉镇痛，观察组在上述镇痛方式中加入帕瑞昔布钠。记录产后疼痛评分［采用视觉模拟量表（VAS）］、镇痛不良反应；分别于术前1 d、产后3 d和产后2周评估产妇的爱丁堡产后抑郁量表（EPDS）评分，记录产后抑郁发生例数；采用酶联免疫法测定血中的BDNF和5-HT水平。采用单因素方差分析和χ²检验进行统计学处理。结果　观察组产后12、24和48 h的VAS评分均低于对照组［（2.23±0.83）分比（3.05±0.82）分、（2.98±0.86）分比（3.78±1.03）分、（3.43±0.87）分比（3.90±0.96）分］，差异均有统计学意义（均P<0.05）；两组在镇痛期间的不良反应总发生率差异无统计学意义（P>0.05）；观察组在产后3 d和产后2周的EPDS评分低于对照组［（7.23±2.55）分比（9.55±3.52）分、（8.15±3.09）分比（9.58±2.78）分］，差异均有统计学意义（均P<0.05）；观察组在产后3 d和产后2周的产后抑郁症发生率低于对照组［7.50%（3/40）比25.00%（10/40）、5.00%（2/40）比22.50%（9/40）］，差异均有统计学意义（均P<0.05）；观察组在产后3 d和产后2周的血清BDNF和5-HT的水平高于对照组（均P<0.05）。结论　帕瑞昔布钠可加强硬膜外吗啡联合地佐辛静脉镇痛的效果，降低剖宫产产后EPDS评分和产后抑郁症的发生率，提高血清BDNF和5-HT水平，且不增加不良反应。

关键词:

剖宫产, 产后抑郁症, 帕瑞昔布钠, 多模式镇痛