不同分娩方式对脐动脉血心房钠尿肽一氧化氮 血管内皮素-1的影响

Impacts of different delivery modes on umbilical arterial blood ANP, NO and ET-1

目的分析不同的分娩方式对脐动脉血心房钠尿肽(ANP)、一氧化氮(NO)和血管内皮素-1(ET-1)的影响。方法选择78名既往健康且无妊娠并发症的初产妇,依据产妇自愿选择分娩方式分为自然分娩组(25例),剖宫产组(26例),分娩镇痛组(27例)。分娩镇痛组宫口开至3 cm时,在腰椎(L2～3)椎间隙行硬膜外穿刺,置入硬膜外导管,连接镇痛泵。待胎儿娩出后,分别抽取3组产妇脐动脉血3 ml,在规定时间离心脐动脉血,以酶联免疫吸附测定法(ELISA)测定ANP、NO、ET-1的水平。结果 3组脐动脉血ANP、NO、ET-1的水平组间比较差异无统计学意义(P>0.05);ANP与NO(r=0.381, P=0.001)和ET-1均呈正相关(r=0.508, P<0.001);NO和ET-1呈正相关(r=0.363, P=0.001)。结论 3种分娩方式对脐动脉血ANP、NO、ET-1的浓度没有影响,说明硬膜外分娩镇痛对胎盘血流量未造成不良影响,具体机制及作用还需要大量样本进行研究证实。

Objective To investigate the impactsof different delivery modes on umbilical arterial blood ANP,NO, and ET-1. Methods Included in this study were 78 primipara who were previously healthy and withno pregnancy complications. According to maternal selection of delivery modes, they were divided into natural delivery group( n=25), Cesarean section(n=26), and analgesic delivery group(n=27). In the analgesic delivery group, when the cervical opening was enlarged up to 3 cm in size, the women received epidural puncture of the L2~3 intervertebral spaceand indwelling of an epidural catheter which was connected to an analgesic pump. After the fetus was delivered, 3 ml of umbilical arterial blood was collected from the three groups of women. The umbilical arterial blood was centrifuged within a specified time, and measured for levels of ANP, NO and ET-1 by enzyme immunosorbent assay(ELISA). Results There were no significant differences in the levels of ANP, NO and ET-1 between the three groups(P>0.05).The ANP level was positively correlated with thoseof NO(r=0.381, P=0.001) and ET-1(r=0.508, P<0.001). The NO level was positively correlated with ET-1 level(r=0.363, P=0.001). Conclusion The three delivery modes in this study did not interfere withthe levels of ANP, NO and ET-1 in umbilical arterial blood, indicating that delivery with epidural analgesia doesnot adversely affect the placental blood flow, although the exact mechanism and implication require fur-ther validation in studies with large sample size.