罗哌卡因联合舒芬太尼硬膜外分娩镇痛方案对疼痛递质及细胞因子生成、应激激素分泌的影响

Effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion

目的:探讨罗哌卡因联合舒芬太尼硬膜外分娩镇痛方案对疼痛递质及细胞因子生成、应激激素分泌的影响。方法:选取在本院接受剖宫产分娩的初产妇218例,经随机数表法将入组产妇分为对照组、观察组各109例。对照组产妇接受产后单纯罗哌卡因硬膜外镇痛,观察组产妇接受产后罗哌卡因联合舒芬太尼硬膜外镇痛。对比两组产妇分娩后即刻(T0)、分娩后6h(T1)、分娩后12h(T2)、分娩后24h(T3),血清中疼痛递质、炎症因子、应激激素含量的差异。结果:T0时,两组产妇血清中疼痛递质、炎症因子、应激激素含量的差异无统计学意义。T1、T2、T3时,观察组产妇血清中NPY、β-EP、SP的含量分别低于对照组产妇对应时间点;观察组产妇血清中IL-1β、hs-CRP、IL-6的含量分别低于对照组产妇对应时间点;观察组产妇血清中Cor、AngⅠ、AngⅡ、NE的含量分别低于对照组产妇对应时间点。结论:初产妇剖宫产后采用罗哌卡因联合舒芬太尼硬膜外镇痛,可有效抑制疼痛递质表达并减轻全身炎症应激反应。

Objective:To discuss the effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion.Methods:218 cases of puerperae who received caesarean section in the hospital between January 2015 and January 2017 were divided into control group(n=109)and observation group(n=109)by random table method.Control group received postpartum ropivacaine epidural analgesia alone,and observation group received postpartum ropivacaine combined with sufentanil epidural analgesia.The differences in serum levels of pain neurotransmitters,inflammatory factors and stress hormones were compared between the two groups immediately after childbirth(T0),6 hafter delivery(T1),12 hafter delivery(T2)and 24 hafter delivery(T3).Results:At T0,the differences in serum levels of pain neurotransmitters,inflammatory factors and stress hormones were not statistically significant between the two groups.At T1,T2 and T3,serum NPY,β-EP and SP levels of observation group were lower than those of control group at corresponding points in time;serum IL-1β,hs-CRP and IL-6 levels of observation group were lower than those of control group at corresponding points in time;serum Cor,AngⅠ,AngⅡ and NE levels of observation group were lower than those of control group at corresponding points in time.Conclusion:Ropivacaine combined with sufentanil epidural analgesia after caesarean section can effectively inhibit the pain neurotransmitter expression and relieve the systemic inflammatory stress response in puerperae.