腰硬联合麻醉复合术后硬膜外镇痛对足月妊娠初产妇无痛分娩产程时间及术后血清PRL、tPA水平的影响

Effect of epidural analgesia after combined spinal and epidural anesthesia on the duration of painless labor and the changes of serum levels of PRL and tPA in full-term pregnancy primipara

目的探讨腰硬联合麻醉复合术后硬膜外镇痛对足月妊娠初产妇无痛分娩产程时间及术后血清催乳素(prolactin,PRL)、组织型纤溶酶原激活物(tissue-type plasminogen activator,tPA)水平的影响。方法选取2015年3月至2017年6月本院98例足月妊娠初产妇为研究对象,采用随机数表法将其分为对照组(49例)和研究组(49例)。对照组产妇采取导乐分娩镇痛,研究组产妇采取腰硬联合麻醉复合术后硬膜外镇痛。比较两组产妇不同时间(分娩前、分娩后2小时、分娩后24小时)血清PRL水平、分娩前后血清tPA水平、产程(第一产程、第二产程、第三产程)时间、不同产程时期视觉模拟评分法(visual analogue scale,VAS)评分、剖宫产率及产后出血量。结果分娩后2小时和24小时,两组产妇血清PRL水平均显著高于分娩前(P均<0.05),且研究组产妇血清PRL水平均显著高于同期对照组(P均<0.05)。分娩后,两组产妇血清tPA水平均显著高于分娩前(P均<0.05),但研究组产妇血清tPA水平显著低于对照组(P<0.05)。研究组产妇第一产程、第三产程时间均显著短于对照组(P均<0.05),但两组产妇第二产程时间比较无显著差异(P>0.05)。镇痛前,两组产妇VAS评分比较差异无显著性(P>0.05),第一产程、第二产程、第三产程时,研究组产妇VAS评分均显著低于对照组(P均<0.05)。研究组产妇剖宫产率显著低于对照(P<0.05),产后出血量显著少于对照组(P<0.05)。结论足月妊娠初产妇行无痛分娩时采取腰硬联合麻醉复合术后硬膜外镇痛,可增加产后PRL分泌量,抑制tPA水平升高,缩短产程,减轻产妇疼痛感,降低剖宫产率,减少产后出血量。

Objective To explore the effect of epidural analgesia after combined spinal and epidural anesthesia on the duration of painless labor and the changes of serum levels of prolactin（PRL） and tissue-type plasminogen activator（t PA） in full-term pregnancy primipara. Method 98 full-term pregnancy primipara in our hospital from March 2015 to June 2017 were randomly divided into control group（n = 49） and study group（n = 49）. Control group primipara took Doula delivery analgesia, and study group primipara were treated with epidural analgesia after combined spinal and epidural anesthesia. Serum PRL levels at different time（before delivery, after delivery of 2 h and 24 h）, serum t PA levels before and after delivery, duration of labor（the first stage of labor, the second stage of labor, the third stage of labor）, visual analogue scale（VAS） scores in different labor period, the rate of cesarean section and postpartum hemorrhage volume were compared between the two groups. Result After delivery for 2 h and 24 h, the serum PRL levels of the two groups were higher than those before delivery（Pall 0.05）, and study group were higher（P〈0.05）. The serum t PA levels of the two groups were higher than those before delivery（Pall 0.05）, but study group was lower（P〈0.05）. The duration of the first stage and the third stage of labor in study group were less than those in control group（Pall 0.05）. There was no significant difference in the second stage of labor between the two groups（P〈0.05）. The VAS scores of the first, second and third stage of labor in study group was lower than study group（Pall〈 0.05）. The cesarean section rate of study group was lower than that of control group（P〈0.05）, the postpartum hemorrhage volume was less than that of control group（P〈0.05）. Conclusion Epidural analgesia after combined spinal and epidural anesthesia in the treatment of full-term pregnancy primiparat can increase the quantity of postpartum PRL secretion, inhibit the increase of t PA content, shorten the stage of labor, relieve the pain, reduce the rate of cesarean section and the postpartum hemorrhage volume.