脊椎-硬膜外联合阻滞分娩镇痛对妊娠期高血压产妇IL-2、TNF-α及血压的影响

Effects of labor analgesia by combined spinal-epidural anesthesia on IL-2,TNF-α and blood pressure in the parturient with pregnancy-induced hypertension

目的 观察脊椎-硬膜外联合阻滞（combined spinal-epidural anesthesia,CSEA）分娩镇痛对妊娠期高血压（Pregnancy-induced Hypertension,PIH）产妇IL-2、TNF-α及血压的影响,探讨分娩镇痛对妊娠期高血压产妇内环境稳定的作用。方法 选择符合入组条件的产妇40例,分为2组：无镇痛组,不予任何镇痛措施。分娩镇痛组,于宫口开至23 cm时实施CSEA分娩镇痛。两组产妇分别在T1（宫口开至2 cm时）、T2（宫口开全时）、T3（产后24h）时抽取静脉血2 ml,采用酶联免疫吸附测定法检测IL-2、TNF-α浓度,并记录视觉模拟评分（Visual Analogue Scale,简称：VAS）、改良Bromage评分及血压等临床指标。结果 ①两组产妇T1、T3时刻VAS评分、MAP差异无统计学意义（P〉0.05）,T2时刻分娩镇痛组VAS评分、MAP较无镇痛组低（P〈0.01）。②分娩镇痛组T2时刻IL-2、TNF-α浓度较无镇痛组低（P〈0.05）,两组IL-2、TNF-α从T1到T2的变化差异有统计学意义（P〈0.01）。结论 CSEA分娩镇痛可有效缓解PIH产妇产程中IL-2、TNF-α的升高幅度,稳定PIH产妇内环境。

Objective To study the effect of labor analgesia by Combined Spinal-Epidural Anesthesia（CSEA） on stabilizing the internal environment of parturients with Pregnancy-induced Hypertension （PIH） by testing IL-2, TNF-a and blood pressure. Methods Forty parturients with PIH corresponded with selected standards were divided into two subgroups.Parrients in group I experienced acute labor pain without any analgesia interference. In group 1I, parturients received combined spinal-epidural analgesia when their cervical dilations were in 2-3 cm after blood sampled. In both groups（n=20）, 2 ml blood samples were taken from the parturient vein at cervical dilation in 2-3 cm （T1）, full dilatation of cervix（T2）, 24 hours after delivery （T3）. The enzyme linked immunosorbent assay（ELISA） method was used to determine IL-2 and TNF-a in all samples. In addition, data on labor progress, Visual Analogue Scale（VAS） score, improved Brom- age score and blood pressure were recorded. Results 1.There were no significant differences in VAS score and mean arterial pressure （MAP）on T1 and T3 （P 〉 0.05 ）; VAS score and MAP in group II were significantly lower than that in group I on T2（P〈 0.01）. 2.The levels of IL-2 and TNF-a in group II were significantly lower than those in group I on T2（P〈 0.05）. The variations of L-2 and TNF-a from T1 to T2 in the two groups were significantly different （P 〈 0.01）. Conclu- sion CSEA analgesia could relieve the elevated tendency of IL-2 and TNF-ct in labor progress and stabilize the internal environment ofparturients with PIH.