nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2024-13-1-56-63nmp-1791Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОценка тревоги и депрессии в периоперационном периоде у женщин репродуктивного возраста при проведении регионарной анестезииAssessment of Anxiety and Depression in the Perioperative Period in Women of Reproductive Age During Regional Anesthesiahttps://orcid.org/0000-0002-7508-8049ЧерныхО. А.ChernykhO. A.

Черных Оксана Александровна - врач анестезиолог-реаниматолог кафедры военной анестезиологии и реаниматологии ФГБВОУ ВО «ВМА им. Кирова» МО РФ.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Oksana A. Chernykh - Anesthesiologist-Resuscitator, Department (Clinic) of Military Anesthesiology and Resuscitation.

6, Academician Lebedev Str., St. Petersburg 194044

ksemykina@yandex.ruhttps://orcid.org/0000-0001-6819-9691ЛахинР. Е.LakhinR. E.

Лахин Роман Евгеньевич - доктор медицинских наук, профессор кафедры (клиники) военной анестезиологии и реаниматологии ФГБВОУ ВО «ВМА им. Кирова» МО РФ.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Oksana A. Chernykh - Anesthesiologist-Resuscitator, Department (Clinic) of Military Anesthesiology and Resuscitation.

6, Academician Lebedev Str., St. Petersburg 194044

doctor-lahin@yandex.ruhttps://orcid.org/0000-0003-4353-4953ЩеголевА. В.ShchegolevA. V.

Щеголев Алексей Валерианович - доктор медицинских наук, профессор, начальник кафедры (клиники) военной анестезиологии и реаниматологии ФГБВОУ ВО «ВМА им. Кирова» МО РФ.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Oksana A. Chernykh - Anesthesiologist-Resuscitator, Department (Clinic) of Military Anesthesiology and Resuscitation.

6, Academician Lebedev Str., St. Petersburg 194044

alekseishegolev@yandex.ruФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» МО РФРоссияS.M. Kirov Military Medical AcademyRussian Federation2024150420241315663Copyright © Черных О.А., Лахин Р.Е., Щеголев А.В., 20242024Черных О.А., Лахин Р.Е., Щеголев А.В.Chernykh O.A., Lakhin R.E., Shchegolev A.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/1791

Введение Периоперационные когнитивные расстройства встречаются как у беременных, так и у небеременных женщин. Прогнозирование, раннее выявление и эффективное лечение этих расстройств имеют важное значение для благополучия женщин и их потомства.

Цель исследования Оценить влияние анестезии и операции на уровень тревоги, депрессии, кратковременной памяти, концентрации внимания у беременных и небеременных женщин.

Материал и методы В обсервационное проспективное исследование включены 120 пациенток, которые были разделены на две равные группы — беременные (n=60) и небеременные (n=60). Проведен сравнительный анализ тестирования психосоматических реакций и когнитивных функций с помощью тестов МoСa-тест, тестов Бентона и Векслера, анкеты самооценки состояния, госпитальной шкалы тревоги, депрессии HADS. Рассчитаны относительный риск и отношение шансов развития тревоги и депрессии.

Результаты Показатели тревоги беременных до операции достигали субклинических значений 7,5 (8,4; 6,6), а у небеременных отмечалась норма 6,5 (7,3; 5,7) (p<0,001), Результаты депрессии у беременных после операции составили 7,3 (8,5; 6,1), у небеременных — норму 6,3 (7; 5,5) (p<0,001). Шанс появления нарушений кратковременной памяти у беременных до операции оказался в 3,1 раза выше, чем у небеременных, отношение шансов 3,1 (95% ДИ [1,3–7,4]). В группе беременных показатель кратковременной памяти до операции был 5 (5,8; 4,2), а после операции снизился до 3,8 (4,7; 2,9) (p<0,001). Отмечено снижение концентрации внимания у беременных: до операции 6,2 (6,8; 5,6), а после нее — 5 (5,8; 4,2) (p<0,001). Относительный риск (RR) развития депрессии у беременных после операции составляет 6,1 раза RR=6,1 (95% ДИ 2,4; 15,8), чувствительность Se (%)=0,9, специфичность Sp (%)=0,5. Относительный риск развития нарушений кратковременной памяти после операции составляет 1,1 раза RR=1,1 (95% ДИ 1; 1,2), чувствительность Se (%)=0,5, специфичность Sp (%)=0,8. Относительный риск развития нарушений концентрации внимания после операции составляет 8,3 раза RR=8 ,3 (95% ДИ 3,9; 18,3), чувствительность Se (%)=0,8, специфичность Sp (%)=0,7.

Заключение Полученные Результаты позволяют сделать Выводы о том, что до операции беременные испытывают субклинический вариант тревоги, на фоне которого возрастают шансы развития нарушений кратковременной памяти и концентрации внимания. После операции у беременных наблюдается субклинический вариант депрессии, наравне с ним также происходит нарушение интеллекта, кратковременной памяти и концентрации внимания. Исходное нарушение памяти и внимания требует подбора анестезиологического обеспечения в группе беременных.

Introduction Perioperative cognitive impairment occurs in both pregnant and non-pregnant women. Prediction, early detection and effective treatment of these disorders are important for the well-being of women and their offspring.

Aim of study To evaluate the effect of anesthesia and surgery on the level of anxiety, depression, short-term memory, and concentration in pregnant and nonpregnant women.

Material and methods The observational prospective study included 120 patients who were divided into two equal groups — pregnant (n=60) and nonpregnant (n=60) women. A comparative analysis of testing psychosomatic reactions and cognitive functions using the MoCa test, Benton and Wechsler tests, selfassessment questionnaire, Hospital Anxiety and Depression Scale (HADS) was carried out. The relative risk and odds ratio of developing anxiety and depression were calculated.

Results Anxiety indicators in pregnant women before surgery reached subclinical values of 7.5 (8.4; 6.6), and in non-pregnant women – the norm: 6.5 (7.3; 5.7) (p<0.001); Results of depression in pregnant women after surgery were 7.3 (8.5; 6.1), in non-pregnant women — the norm: 6.3 (7; 5.5) (p<0.001). The odds of developing short-term memory impairment in pregnant women before surgery was 3.1 times higher than in non-pregnant women, odds ratio 3.1 (95% CI [1.3–7.4]). In the pregnant group, short-term memory scores before surgery were 5 (5.8; 4.2), and after surgery they decreased to 3.8 (4.7; 2.9) (p<0.001). There was a decrease in concentration of attention in pregnant women: before surgery 6.2 (6.8; 5.6), and after surgery — 5 (5.8; 4.2) (p<0.001). The relative risk (RR) of developing depression in pregnant women after surgery was 6.1 times RR=6.1 (95% CI 2.4; 15.8), sensitivity Se (%)=0.9, specificity Sp (%)=0.5. The relative risk (RR) of developing short-term memory impairment after surgery was 1.1 times RR=1.1 (95% CI 1; 1.2), sensitivity Se (%)=0.5, specificity Sp (%)=0, 8. The relative risk (RR) of developing problems with concentration after surgery was 8.3 times RR=8.3 (95% CI 3.9; 18.3), sensitivity Se (%)=0.8, specificity Sp (%)=0.7.

Conclusions The Results obtained allow us to conclude that before surgery, pregnant women experience a subclinical version of anxiety, against the background of which the chances of developing problems with short-term memory and concentration increase. After surgery, pregnant women experience a subclinical version of depression, along with it there is also impairment of intelligence, short-term memory and concentration. The initial impairment of memory and attention requires the selection of anesthesia in a group of pregnant women.

беременностьтревогадепрессияpregnancyanxietydepressionReferencesO’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):3–12 PMID: 24140480 https://doi.org/10.1016/j.bpobgyn.2013.09/002O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):3–12 PMID: 24140480 https://doi.org/10.1016/j.bpobgyn.2013.09/002Vivencio V, Nardi B, Bellantuono C. Depression in pregnancy: focus on the safety of antidepressant drugs. Recenti Prog Med. 2018;109(9):432– 442. PMID: 30303187 https://doi.org/10.1701/2990.29929Vivencio V, Nardi B, Bellantuono C. Depression in pregnancy: focus on the safety of antidepressant drugs. Recenti Prog Med. 2018;109(9):432– 442. PMID: 30303187 https://doi.org/10.1701/2990.29929Parsons TD, Thompson E, Buckwalter DK, Bluestein BW, Stanczyk FZ, Buckwalter JG. Pregnancy history and cognition during and after pregnancy. Int J Neurosci. 2004;114(9):1099–1110. PMID: 15370176 https://doi.org/10.1080/00207450490475544Parsons TD, Thompson E, Buckwalter DK, Bluestein BW, Stanczyk FZ, Buckwalter JG. Pregnancy history and cognition during and after pregnancy. Int J Neurosci. 2004;114(9):1099–1110. PMID: 15370176 https://doi.org/10.1080/00207450490475544Nakić Radoš S, Tadinac M, Herman R. Anxiety during pregnancy and postpartum: course, predictors and comorbidity with postpartum depression. Acta Clin Croat. 2018;57(1):39–51. PMID: 30256010 https://doi.org/10.20471/acc.2017.56.04.05Nakić Radoš S, Tadinac M, Herman R. Anxiety during pregnancy and postpartum: course, predictors and comorbidity with postpartum depression. Acta Clin Croat. 2018;57(1):39–51. PMID: 30256010 https://doi.org/10.20471/acc.2017.56.04.05Apter G, Devouche E, Gratier M. Perinatal mental health. J Nerv Ment Dis. 2011;199(8):575–577. PMID: 21814083 https://doi.org/10.1097/NMD.0b013e318225f2f4Apter G, Devouche E, Gratier M. Perinatal mental health. J Nerv Ment Dis. 2011;199(8):575–577. PMID: 21814083 https://doi.org/10.1097/NMD.0b013e318225f2f4Добряков И.В. Перинатальная психология. Санкт-Петербург: Питер, 2010.Dobryakov IV. Perinatal’naya psikhologiya. Saint Petersburg: Piter Publ., 2010. (in Russ.)Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull. 2003:67:219–229. PMID: 14711766 https://doi.org/10.1093/bmb/ldg011Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull. 2003:67:219–229. PMID: 14711766. https://doi.org/10.1093/bmb/ldg011Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecology study. Am J Obstet Gynecol. 2000;183(3):759–769. PMID: 10992206 https://doi.org/10.1067/mob.2000.106580Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecology study. Am J Obstet Gynecol. 2000;183(3):759–769. PMID: 10992206 https://doi.org/10.1067/mob.2000.106580Хломов, К.Д., Ениколопов С.Н. Влияние психоэмоциональных и индивидуально-характериологических особенностей на течение беременности женщин с угрозой прерывания. Сибирский психологический журнал. 2007;(26):148–153.Khlomov KD, Enikolopov SN. Influence of Psycho-Emotional and Individual Characteristics on the Course of Pregnancy in Women with Threatened Miscarriage. Siberian Journal of Psychology. 2007;(26):148– 153. (In Russ.).Шмуклер А.Б. Психозы беременности: обзор литературы. Проблемы репродукции. 1995;(2):19–22.Shmukler AB. Psikhozy beremennosti: obzor literatury. Russian Journal of Human Reproduction. 1995;(2):19–22.Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001;63(5):830-834. PMID: 11573032 https://doi.org/10.1097/00006842-200109000-00017Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001;63(5):830–834. PMID: 11573032 https://doi.org/10.1097/00006842-200109000-00017Dayan J, Creveuil C, Herlicoviez M, Herbel C, Baranger E, Savoye C, Thouin A. Role of anxiety and depression in the onset of spontaneous preterm labor. Am J Epidemiol. 2002;155(4):293–301. https://doi.org/10.1093/aje/155.4.293Dayan J, Creveuil C, Herlicoviez M, Herbel C, Baranger E, Savoye C, Thouin A. Role of anxiety and depression in the onset of spontaneous preterm labor. Am J Epidemiol. 2002;155(4):293–301. https://doi.org/10.1093/aje/155.4.293McDonald RL. The role of emotional factors in obstetric complications: a review. Psychosom Med. 1968;30(2):222–237. PMID: 4873519 https://doi.org/10.1097/00006842-196803000-00007McDonald RL. The role of emotional factors in obstetric complications: a review. Psychosom Med. 1968;30(2):222–237. PMID:4873519 https://doi.org/10.1097/00006842-196803000-00007Ahokas A, Kaukoranta J, Wahlbeck K, Alto M. Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17 beta-estradiol: a preliminary study. J Clin Psychiatry. 2001;62(5):332–336. PMID: 11411813 https://doi.org/10.4088/jsp.v62n0504Ahokas A, Kaukoranta J, Wahlbeck K, Alto M. Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17 beta-estradiol: a preliminary study. J Clin Psychiatry. 2001;62(5):332–336. PMID:11411813 https://doi.org/10.4088/jsp.v62n0504Payne JL. The role of estrogen in mood disorders in women. Int Rev Psychiatry. 2003;15(3):280–290. PMID :15276966 https://doi.org/10.1080/0954026031000136893Payne JL. The role of estrogen in mood disorders in women. Int Rev Psychiatry. 2003;15(3):280–290. PMID:15276966 https://doi.org/10.1080/0954026031000136893Sherwin BB. Estrogenic effects on the central nervous system: clinical aspects. In: Lindsay R, Dempster DW, Jordan VC. (eds.). Estrogens and Antiestrogens: basic and clinical aspects. Philadelpfia: Lippincott-Raven; 1997. p. 75–87.Sherwin BB. Estrogenic effects on the central nervous system: clinical aspects. In: Lindsay R, Dempster DW, Jordan VC. (eds.). Estrogens and Antiestrogens: basic and clinical aspects. Philadelpfia: Lippincott-Raven; 1997. p. 75–87.Wieck A, Kumar R, Hirst AD, Marks MN, Campbell IC, Checkley SA. Increased sensitivity of dopamine receptors and recurrence of affective psychosis after child-birth. BMJ. 1991;303(6803):613–616. PMID: 1805821 https://doi.org/10.1136/bmj.303.6803.613Wieck A, Kumar R, Hirst AD, Marks MN, Campbell IC, Checkley SA. Increased sensitivity of dopamine receptors and recurrence of affective psychosis after child-birth. BMJ. 1991;303(6803):613–616. PMID: 1805821 https://doi.org/10.1136/bmj.303.6803.613Deakin JF. Relevance of hormone CNS interactions to psychological changes in the puerperum. In: Kumar R, Brockington IF. (eds.). Motherhood and Mental Illness: Causes and consequences. London: Butterworth; 1989. p. 113–132.Deakin JF. Relevance of hormone CNS interactions to psychological changes in the puerperum. In: Kumar R, Brockington IF. (eds.). Motherhood and Mental Illness: Causes and consequences. London: Butterworth; 1989. p. 113–132.Bloch M, Shmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157(6):924–930. PMID: 10831472 https://doi.org/10.1176/appi.ajp.157.6.924Bloch M, Shmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157(6):924–930. PMID:10831472 https://doi.org/10.1176/appi.ajp.157.6.924Bodnar LM, Wisner KL, Moses-Kolko E, Sit DK, Hanusa BH. Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy. J Clin Psychiatry. 2009;70(9):1290– 1296. PMID: 19607761 https://doi.org/10.4088/JCP.08m04651Bodnar LM, Wisner KL, Moses-Kolko E, Sit DK, Hanusa BH. Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy. J Clin Psychiatry. 2009;70(9):1290– 1296. PMID:19607761 https://doi.org/10.4088/JCP.08m04651Flynn HA, Chermack ST, Chermack T. Prenatal alcohol use: the role of lifetime problems with alcohol, drugs, depression, and violence. J Stud Alcohol Drugs. 2008;69(4):500–509. PMID: 18612565 https://doi.org/10.15288/jsad.2008.69.500Flynn HA, Chermack ST, Chermack T. Prenatal alcohol use: the role of lifetime problems with alcohol, drugs, depression, and violence. J Stud Alcohol Drugs. 2008;69(4):500–509. PMID:18612565 https://doi.org/10.15288/jsad.2008.69.500Kallen B, Olausson PO. Maternal use selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Safe. 2008;17(8):801–806. PMID: 18314924 https://doi.org/10.1002/pds.1570Kallen B, Olausson PO. Maternal use selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Safe. 2008;17(8):801–806. PMID:18314924. https://doi.org/10.1002/pds.1570Cripe SM, Frederick IO, Qui C, Williams MA. Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy. Paediatr Perinat Epidemiol. 2011;25(2):116–123. PMID: 21281324 https://doi.org/10.1111/j.1365-3016.2010/01182.xCripe SM, Frederick IO, Qui C, Williams MA. Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy. Paediatr Perinat Epidemiol. 2011;25(2):116–123. PMID:21281324. https://doi.org/10.1111/j.1365-3016.2010/01182.xLi D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod. 2009;24(1):146–153. PMID: 18948314 https://doi.org/10.1093/humper/den342Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod. 2009;24(1):146–153. PMID:18948314. https://doi.org/10.1093/humper/den342Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A Meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–1024. PMID: 20921117 https://doi.org/10.1001/archgenpsychiatry.2010.111Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A Meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–1024. PMID:20921117. https://doi.org/10.1001/archgenpsychiatry.2010.111Britton JR. Infant temperament and maternal anxiety and depressed mood in the early postpartum period. Women Health. 2011;51(1):55–71. PMID: 21391161 https://doi.org/10.1080/03630242.2011.540741Britton JR. Infant temperament and maternal anxiety and depressed mood in the early postpartum period. Women Health. 2011;51(1):55–71. PMID:21391161. https://doi.org/10.1080/03630242.2011.540741Deave T, Heron J, Evans J, Emond A. The impact of maternal depression in pregnancy on early child development. BJOG. 2008;115(8):1043–1051. PMID: 18651886 https://doi.org/10.1111/j.1471-0528.2008.01752.xDeave T, Heron J, Evans J, Emond A. The impact of maternal depression in pregnancy on early child development. BJOG. 2008;115(8):1043–1051. PMID: 18651886. https://doi.org/10.1111/j.1471-0528.2008.01752.xPaulson JF, Keefe HA, Leiferman JA. Early parental depression and child language development. J Child Psychol Psychiatry. 2009;50(3):254–262. PMID: 19175819 https://doi.org/10.1111/j.1469-7610.2008.01973.xPaulson JF, Keefe HA, Leiferman JA. Early parental depression and child language development. J Child Psychol Psychiatry. 2009;50(3):254–262. PMID:19175819. https://doi.org/10.1111/j.1469-7610.2008.01973.xОвезов А.М., Пантелеева М.В., Князев А.В., Луговой А.В., Брагина С. В. Когнитивная дисфункция и общая анестезия: от патогенеза к профилактике и коррекции. Неврология, нейропсихиатрия, психосоматика. 2016;8(3):101–105.Ovezov AM, Panteleeva MV, Knyazev AV, Lugovoy AV, Bragina SV. Cognitive dysfunction and general anesthesia: from pathogenesis to prevention and correction. Neurology, Neuropsychiatry, Psychosomatics. 2016;8(3):101–105. (In Russ.) https://doi.org/10.14412/2074-27112016-3-101-105

The authors declare that there are no conflicts of interest present.