剖宫产与阴道分娩对前次剖宫产再次妊娠产妇的应激及炎性状态分析

Analysis of the stress and inflammatory state of pregnant women with scarred uterus when experienced cesarean section or vaginal delivery

目的:评价剖宫产与阴道分娩对疤痕子宫再次妊娠产妇围产期应激和炎性反应的影响。方法:连续选择2015年01月-2016年12月入本院诊断为疤痕子宫再次妊娠产妇共120例,其中剖宫产与阴道分娩各60例。分别于产前、产后12h、24h和48h,采用放射免疫法检测外周静脉血应激反应指标皮质醇(Cor)、去甲肾上腺素(NE)和β-内啡肽(β-EP)水平,ELISA法检测炎症反应指标C-反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,比较两组产后并发症发生情况。结果:两组产后各应激反应指标均升高至12h时达到峰值,然后回落(P<0.05),不同时间点两组应激反应指标水平比较无差异(P>0.05)。两组产后各炎症反应指标均升高至24h时达到峰值,然后回落(P<0.05),不同时间点两组的炎症反应指标水平比较无差异(P>0.05)。两组孕妇产后并发症发生率比较无差异(P>0.05)。结论:疤痕子宫再次妊娠产妇可根据瘢痕愈合情况选择分娩方式,采用阴道分娩并未增加围产期应激和炎性反应。

Objective： To evaluate the stress and inflammatory state of pregnant women with scarred uterus when expe- rienced cesarean section or vaginal delivery. Methods： From January 2015 to December 2016, 120 pregnant women with scarred uterus in Zhengzhou City Maternal and Child Health Care were divided into cesarean section group and va- ginal delivery group （60 women in each group）. The levels of cortisol （COR）, norepinephrine （NE）, β-endorphin （β- EP）, C-ractive protein（CRP）, interleukin-6（IL-6） and tumor necrosis factor-alpha （TNF-α） were measured at 12 h, 24 h and 48 h after delivery. The Cor, NE and β-EP were measured by radioimmunoassay, and the CRP, IL-6 and TNF-α were measured by ELISA. The postpartum complications were compared between the two groups. Results： The value of postpartum stress response indicators of women in both groups increased, and peak value appeared at postpar- tum 12 h, and then the value dropped （P〈0.05）. The value of postpartum inflammation factors of women in both groups also increased, and peak value appeared at postpartum 24 h, and then the value dropped （P~ 0.05）.There was no significant differences in value of stress response indicators or inflammatory factors at different time points between the two groups （P〉0.05）. There was no significant difference in the incidence of postpartum complications between the two groups （P〉0.05）. Conclusion.. Pregnant women with scarred uterus should choose cesarean section or vaginal delivery according to the situation of scar healing. Vaginal delivery does not increase perinatal stress and inflammatory response.