两种不同脊神经阻滞对妊娠高血压综合征患者血浆一氧化氮水平影响的比较

A COMPARISON OF THE EFFECTS OF TWO DIFFERENT SPINAL NERVE BLOCK ON THE PLASSMA NITRIC OXIDE (NO) LEVEL IN PREGNANCY INDUCED HYPERTENSION (PIH) PATIENTS

目的 :本研究通过对蛛网膜下腔阻滞和硬膜外阻滞两种不同脊神经阻滞方法后 ,妊娠高血压综合征 (PIH)患者血浆一氧化氮水平的测定 ,比较两者效果 ,为临床治疗PIH提供更佳的方法。方法 :采用Griess法测定 2 0例重度PIH患者经蛛网膜下腔阻滞和硬膜外阻滞 (每组各 10例 )后血浆一氧化氮水平。以 10例健康非妊娠妇女 (NNP)及 2 0例同期住院正常晚妊妇女 (NLP)做对照。结果 :PIH患者经蛛网膜下腔阻滞和硬膜外阻滞后 ,两组患者的收缩压和舒张压相比有显著降低 (P<0 .0 5) ,但两组间相比无显著性差异 (P >0 .0 5)。NLP组体内血浆一氧化氮的浓度 ( 4 9.99± 6.86mmol/L)与NNP组 ( 4 3.99± 4 .0 5mmol/L)相比明显升高 (P <0 .0 5) ,PIH患者体内血浆一氧化氮的浓度 ( 38.11± 4 .953mmol/L)与NLP妇女相比明显降低 (P <0 .0 1)。蛛网膜下腔阻滞后NLP组 ( 66.8± 6.51mmol/L) ,PIH组 ( 53.96± 3.58mmol/L)较阻滞前明显升高 (P <0 .0 1)。硬膜外阻滞后 ,NLP组 ( 67.95± 6.79mmol/L) ,PIH组 ( 70 .88± 7.6mmol/L)血浆一氧化氮的浓度较阻滞前升高更明显 (P <0 .0 1)。同时发现NLP组蛛网膜下腔阻滞和硬膜外阻滞两种阻滞方法对血浆一氧化氮水平影响无显著差异 (P >0 .0 5) 。

Objective: To determine the plasma nitric oxide level in PIH patients after subarachnoid block (SB, n=10) and epidural block (EB, n=10 ), in an attempt to find out a better treatment for PIH. Method: To determine the plasma NO level in 20 cases of severe PIH after SB and EB using Griess method. Healthy normal non pregnancy (NNP) women (n=10) and normal late pregnancy(NLP) women (n=20) were used as control. Results: There were significant decreases in systolic and diastolic pressure after thet nerve block ( P <0.05). There was no significant difference observed between SB and NB groups( P >0.05). The plasma NO level in NLP group(49.99±6.86umol/L) was significantly higher than that in NNP group (43.99±4.05umol/L)( P <0.05). The plasma NO level in PIH patients(38.11±4.95umol/L) was much lower than that in NLP group ( P <0.01). After SB, The plasma NO level in PIH patients(53.96±3.58umol/L) and NLP group (66.8±6.51umol/L) increases significantly ( P <0.01). After EB, the plasma NO level in PIH patients(70.88±7.6umol/L) and NLP group(67.95±6.79umol/L) increased much more markedly ( P <0.01). There was no significant difference between effects of EB and SB on the plasma NO level in NLP group( P >0.05), while the plasma NO level in PIH group was much higher after EB than that after SB ( P <0.01). Conclusions: The plasma NO level in PIH patients is lower than that of normal late pregnancy women. The NO level of PIH patients increases after spinal nerve block, and EB is more effective than SB in increasing the plasma NO level.