Clinical Study On Prevention Of Postpartum Depression With Dexmedetomidine During Painless Delivery

Purpose:To observe the analgesic and sedative effects of Dexmedetomidine(DEX)in painless delivery as a local anesthetic adjuvant,and to explore whether it can help reduce the occurrence of Postpartum Depression(PPD),which will provide reference for anesthesiologists in the selection of painless delivery drugs and the prevention of postpartum depression in the future.Method:In this study,84 parturients at the beginning of labor were selected and divided into RD(Ropivacaine combined with dexmedetomidine)group and RS(Ropivacaine combined with sufentanil)group after the standard screening.Informed consent was signed for all women in both groups before performing painless labor.After intravenous access and ECG monitoring were established in the delivery room,anesthesia puncture was performed.Parturients in RD group were injected with ropivacaine 2mg combined with DEX 5μg into the subarachnoid space,and then 100 ml of ropivacaine combined with DEX 45μg in total with analgesic pump for patient-controlled epidural analgesia(PCEA).The combination of 2 mg ropivacaine and 5 μg of sufentanil in RS group was effective.Then 100 ml of Ropivacaine and 45 μg of sufentanil were injected into 100 mg of PCEA.PCEA parameters in both groups were set as(8ml/h continuously pumped,8ml/h patient-controlled,15 min interval),and continuous infusion until delivery was completed.The main observation index are EPDS score(Edinburgh Postnatal Depression SCcale)and positive rate of PPD were collected before analgesic delivery(E0),postpartum week1(E1)and postpartum week 6(E2)in the form of a questionnaire survey;Observe the analgesic and sedative effects;To investigate whether maternal satisfaction with pain treatment and pain relief reached the expected level;The hemodynamic changes of the two groups were monitored;Monitoring of labor conditions(e.g.labor duration,adverse reactions,Apgar score of newborn,etc.).This study has passed the ethical review of the Affiliated Hospital of Yan ’an University and the approval number is S-S20210011.Results:1.General information did not differ significantly between the two groups.(P > 0.05).2.Compared with RS group,EPDS score of RD group was significantly lower in E1 and E2(P < 0.001).EPDS scores in RD group showed a downward trend,and EPDS scores in E1 and E2 had significant differences with E0(P < 0.001),while EPDS scores in RS group showed an upward trend,and EPDS scores in E1 and E2 had significant differences with E0(P < 0.001).The incidence of PPD after 1 week in RD group was obviously lower than that in RS group(2.5% vs 15%),also there was a obvious difference(P<0.05).At 6 weeks postpartum,compared to RS group,the rate of PPD in RD group was significantly lower(2.5%vs22.5%),and the difference was obviously significant(P < 0.001).3.The VAS scores at V1,V2 and V3 of the two groups significantly decreased than those at V0(P < 0.001).At V1,V2 and V3,the VAS scores of RD group were significantly lower than those of RS group(P < 0.05),and the Ramsay scores of RD group(3.75 ± 0.44 vs 2.68 ± 0.57)were significantly higher than those of RS group(P <0.001).4.The satisfaction rate in RD group and RS group was 87.5% and 67.5%,respectively,and the satisfaction degree of the former was obviously higher than that of the latter(P < 0.05).The expected agreement degree of RD group and RS group was82.5% and 60%,respectively.The expected agreement degree of the former was significantly higher than that of the latter(P < 0.05).5.The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of the parturient are in normal range.However,at T1,T2,T3,the SBP,DBP and HR of RD group were compared with those of RS group(P < 0.05).Both the RD group and the RS group did not require vasoactive drugs to maintain hemodynamic stability.6.In RD group,the 1st labor period was shorter than that in RS group(P < 0.001).No significant difference was found in the 2nd and 3rd stages of labor(P > 0.05).7.The incidence of skin pruritus in RD group was significantly lower than that in RS group(0% vs 15%),and the difference was statistically significant(P < 0.05).Conclusion:The application of DEX as a local anesthetic adjuvant in painless labor under CSEA not only can significantly reduce the EPDS score and PPD positive rate at 1 and 6 weeks after delivery,but also can provide good analgesic and sedative effect,and the incidence of adverse reactions is less.