Effects Of Dexmedetomidine On Postpartum Depression In Puerpera Undergoing Combined Spinal And Epidural Anesthesia For Selective Cesarean Section

BackgroundThe postpartum depression?PPD?is a common mental illness after delivery,and its incidence in China is 16.3-24.2%[1,2].PPD seriously affects the physical and mental health of puerperae and newborns[3].The findings of studies show that the cesarean section?CS?is one of the important risk factors of PPD[4,5],and related adverse events,such as tension and anxiety,sleep disturbance,shiver,visceral traction reaction,nausea and emesis,and insufficient analgesia etc.,not only cause physiological pains to puerperae,but also may cause psychological traumas and further increase the occurrence of PPD[6].Therefore,how to effectively reduce the occurrence of PPD is not only a medical problem,but also a social public health problem.Dexmedetomidine?DEX?is a highly selective?2-adrenergic receptor agonist ??2-AR?.It has sedative,analgesic,sympatholytic,antianxiety and anti-inflammatory effects,produces interruptable physiologic sleep without respiratory inhibition[7-9],and stabilizes intraoperative hemodynamic status in CS,reduces shivers,nausea and vomiting,and improves sleep[10-13].There are also studies that assert that DEX may have the effect of preventing PPD[14].Nevertheless,the use of sedatives in CS is more cautious because of the safety of puerperae and fetuses,so the application of DEX in this field is less studied.Recent studies state that the use of DEX does not increase perioperative risks of puerperae and fetuses,s?ggesting that DEX used for CS anesthesia may be safe [15-17].Therefore,this study will observe the effect of DEX on puerperal PPD in CS under combined spinal and epidural anesthesia?CSEA?.ObjectiveTo observe the anesthesia effect of DEX used to puerperae in CS under CSEA and its effect on PPD so as to provide reference and basis for application in obstetric anesthesia and the prevention and treatment of PPD after CS.Methods1.Objects and Methods:226 puerperae undergoing elective CS under CSEA,ASA I-II grade,in Zhongshan City People's Hospital from April 2019 to November 2019 was selected.They were divided into experimental group?DEX group?and control group?NS group?using the random number table method.Both groups were anesthetized with combined spinal and epidural anesthesia,15mg 0.5%ropivacaine for epidural anesthesia.In accordance with the principle of the double-blind method,the nurse anesthetist assigned the experimental agents with the same appearance to the anesthetist ten minutes before operation according to the random number table:DEX solution with concentration of 4?g/ml?experimental group?or saline in equal volume?control group?were delivered to the anesthesiologist,and the content of the experimental agent was kept confidential.After the data collection of this study was completed,the random number table was handed over to the anesthetist.The anesthetist administered intravenous pumping of the experimental agent with the dose of 0.8?g/kg after delivery,the completion time of intravenous pumping was 10 minutes,and the anesthetist recorded the required data truthfully.2.Observation indicators:?1?General information:age,gestational weeks,body mass index?BMI?,history of pregnancy and childbirth,education level,household per capita income,neonatal Apgar score and birth weight?BW?,operation time.?2?Mean arterial pressure?MAP?,heart rate?HR?,saturation of pulse oxygen?SpO₂?,OAA/S sedation score respectively at the time of entry into the operating room?T1?,10 minutes after successful combined spinal and epidural anesthesia?T2?,10minutes after DEX/NS pumping?T3?;numerical rating scale?NRS?at the time of?T2?and end of operation?T4?;SDS indexes before operation?T0?and 24 hours after operation?T5?,PSQI score and EPDS score 1 week?T6?and 6 weeks?T7?after operation;puerperal adverse reactions?hypotension,thirst,nausea and emesis,shiver,visceral traction reaction?after delivery.3.Statistical analysis:In this study,the mean±standard deviation?X±S?)was applied to statistically describe the quantitative data.The ratio?composition ratio?was utilized to describe qualitative materials.Two independent samples t test was adopted to analyze differences between the two groups,and paired samples t test was used for intragroup comparison.Paired^c2 test was used for composition ratio difference between different groups and intragroup comparison.Fitting multiple linear regression was employed to analyze the influencing factors of postpartum depression.Each test level was set as?=0.05,that is,if P<0.05,the difference was statistically significant.All of the above analyses were implemented with SPSS22.0 software package.ResultsFinally,200 cases were included in this study,100 cases in the experimental group and 100 cases in the control group.1.No statistical difference in general?P>0.05?.2.MAP,SpO₂ differences of all puerperae at T1?T3 observation points respectively were not statistically significant?P>0.05?.3.HR of the experimental group decreased at T3?80.46±11.88?compared with that at T1?85.76±16.88??P<0.05?,and it was significantly lower than that of the control group?87.72±10.09??P<0.05?at the same observation point.OAA/S sedation score of the experimental group at T3?2.60±0.64?was significantly higher than that of the control group?1.32±0.47??P<0.05?.4.NRS scores of the experimental group at T4 and T5?1.02±0.65,1.08±0.63?decreased compared with that at T2?1.52±1.07?and both were lower than those of the control group at the same observation points?1.29±0.76,1.40±0.62??P<0.05?.5.PSQI scores of the experimental group decreased at T5?T6?T7?8.6±3.75,7.18±2.76,9.01±2.81?compared with that at T0?10.68±2.82??P<0.05?and all were lower than those of the control group at the same observation points?11.26±3.67,10.99±4.33,10.56±3.67??P<0.05?.The difference was statistically significant.6.SDS index of the experimental group at T5?0.42±0.14?decreased compared with that at T0?0.53±0.22??P<0.01?and lower than that of the control group at T5?0.47±0.15??P<0.05?.At T5,the incidence?12%?that SDS index of the experimental group was equal or greater than 0.6?moderate and severe depression?was significantly lower than that of the control group?29%??P<0.05?.The average EPDS scores of the experimental group at T6?T7?6.82±2.2,6.63±1.79?were lower than those of the control group at the same observation points?7.72±2.97,7.43±2.71??P<0.05?.At T6?T7,the incidences of puerperal depression?EPDS?13?in the experimental group?6%,1%?were lower than those of the control group?15%,8%??P<0.05?.7.The incidences of nausea and emesis,shiver,visceral traction reaction,hypotension in the experimental group?4%?2%?3%?5%respectively?was significantly lower than those of the control group?20%?22%?15%?14%respectively??P<0.05?.The number of thirst cases?8 cases?was more than that in the control group?3 cases?,but the difference was not statistically significant?P>0.05?.8.By use of backward fitting multiple linear regression model,it was shown that the lighter BW was,the higher SDS index at T5 tended to be;the higher the education level was,the lower SDS index at T5 tended to be?F=7.978,P<0.05?.The higher the household per capita income was,the lower EPDS score at T6 tended to be;the lighter BW was,the higher EPDS score at T6 tended to be?F=3.925,P<0.05?.The higher the education level was,the lower EPDS score at T7 tended to be;the higher the household per capita income was,the lower EPDS score at T7 tended to be?F=147.588,P<0.05?.The lower OAA/S score at T3 and NRS score at T5 were,the lower SDS index at T5,EPDS score at T6 and EPDS score at T7 tended to be?P<0.05?.Conclusion1.The use of DEX?with the dose of 0.8?g/kg?in CS under CSEA can provide satisfactory sedation and enhanced analgesic effect,reduce the occurrence of intraoperative adverse events,improve postoperative sleep,no adverse effect on puerperal circulation and respiration,reduce occurrence of PPD after operation.2.Intraoperative sedation score,neonatal BW,education level and household per capita income were negatively correlated with puerperal early depression status after CS;pain score 24h after operation were positively correlated with puerperal early depression status after CS.