精神心理因素对分娩发动的影响及机制

Effect of psychic factors on onset of parturition and its mechanism

目的探讨精神心理因素对初产妇分娩的影响及诱发分娩的可能机制。方法将住院待产的单胎初产妇分为正常晚期妊娠组和早产组,每组37例,采用SCL-90量表进行精神心理行为评估;临产后1h(Phase1)、产后24h(Phase2)分别采集静脉血3ml,采用放射免疫学方法和ELISA法测定血浆促肾上腺皮质素释放激索(CRH)及环氧化酶-2(COX-2)水平。结果正常晚期妊娠组和早产组间精神心理行为指标无统计学差异(P>0.05);血浆CRH水平均较基础状态明显升高,分别为(258±45)μg/L和(250±39)μg/L(P<0.05);血浆COX-2水平均较基础状态明显升高,分别为6.5±3.8ng/ml和6.0±3.8ng/ml(P<0.05);焦虑与妊娠末期CRH、COX-2水平显著相关(r=-0.403,P=0.011;r=-0.399,P=0.032),恐怖情绪亦与妊娠末期CRH、COX-2水平显著相关(r=-0.357,P=0.017;r=-0.423,P=0.025)。结论焦虑和恐怖情绪可能增加孕妇胎盘CRH的分泌水平,进而提高孕妇血浆COX-2而参与分娩发动。

Objective To study the effect of psychic factors on parturition of primiparae and its possible mechanism. Methods Primiparae admitted to our hospital were divided into late pregnancy group and premature labor group （n=37 each）. Their psychic factors were evaluated with a SCL-90 scale. Three ml of venous blood was collected lh （phasel） after parturient and 24h（phase 2） after parturition, respectively, for the measurement of plasma corticotrophin releasing hormone （CRH） and COX-2 levels by radioimmunoaasay and ELISA. Results No significant difference was found in psychic factors between the late pregnancy group and the preterm group （P〉0.05）. The levels of plasma CRH （258 ± 45μg/L and 250±39 μg/L） and COX-2 （6.5 ±3.8ng/ml and 6.0 ± 3.8 ng/ml） were significantly higher than their fundamental levels （P〈0.05）. Anxiety and phobia emotion were significantly related with the plasma level of CRH and COX-2 in the third trimester of pregnancy （r=-0.403 and -0.399, r=-0.357 and -0.423, P〈0.05）. Conclusion Anxiety and phobia emotion can increase the CRH level in placenta, leading to elevation of plasma COX-2 level which participates in onset of parturition.