右美托咪定联合程控硬膜外脉冲式注射分娩镇痛对产妇去甲肾上腺素及胎儿脐动脉血心钠素、内皮素1水平的影响

Effect of dexmedetomidine combined with PIEB on serum norepinephrine level in pregnant women and the levels of atrial natriuretic peptide and endothelin-1 in fetal umbilical artery

目的:探讨右美托咪定联合程控硬膜外脉冲式注射(PIEB)分娩镇痛对产妇去甲肾上腺素(NA)及胎儿脐动脉血心钠素(ANP)、内皮素1(ET-1)水平的影响。方法:将在上海市闵行区中心医院接受PIEB分娩镇痛的120例产妇,按随机数字表法分为试验组和对照组,每组60例,均接受规律性间断硬膜外注射,试验组在麻醉平面测试完成后给予右美托咪定静脉持续泵入,宫口开至10cm时停止泵入。记录分娩镇痛前(T0)和镇痛后1h(T1)、镇痛后2h(T2)、镇痛后3h(T3)以及宫口开至6cm时(T4)、分娩时(T5)、宫口开全时(T6)及分娩后1h(T7)产妇的生命体征,比较两组分娩镇痛参数、分娩情况及视觉模拟(VAS)评分。采用酶联免疫吸附试验(ELISA)法检测产妇T0时及T1时血清NA水平和胎儿脐动脉血ANP、ET-1水平。结果:两组产妇T1时平均动脉压(MBP)、心率(HR)均较T0时下降(P<0.05),两组比较差异均无统计学意义(均P>0.05)。两组T1~T7时的VAS评分均较T0时显著下降(均P<0.05),且T2~T7时试验组低于对照组(P<0.05)。两组产妇分娩镇痛时间、器械助产率、剖宫产率及两组新生儿1min和5min时Apgar评分比较,差异均无统计学意义(均P>0.05)。试验组硬膜外用药量较对照组减少,且第二产程时间较对照组缩短(P<0.05)。两组产妇T1时血浆NA水平较T0时均下降,且试验组下降程度更为显著(P<0.05)。试验组胎儿脐动脉血ANP、ET-1水平显著高于对照组(P<0.05)。结论:右美托咪定联合PIEB分娩镇痛可以降低产妇血NA水平,提高胎儿脐动脉血ANP和ET-1水平,进而调节胎儿胎盘供血。

Objective: To investigate the effect of dexmedetomidine combine with programmed intermittent epiduarl bolus (PIEB) on serum norepinephrine (NA) level in pregnant women and the atrial natriuretic peptide (ANP) and endothelin-1 (ET-1) levels in fetal umbilical artery. Methods: A total of 120 pregnant women who received PIEB labor analgesia in our hospital were randomly divided into a test group and a control group,with 60 cases in each group.They all received regular intermittent epidural injection,and the women in the test group were given dexmedetomidine until uterine open to 10 cm,after the completion of anesthesia plane testing.Before analgesia (T0) and after 1 h (T1),2 h (T2),3 h (T3) of analgesia,hysterostomy opening to 6 cm (T4),during labor (T5),at the second stage of labor (T6) and 1 h after labor (T7),the vital signs and the visual analogue scale (VAS) score were recorded.The labor analgesia parameters and delivery situation,as well as the serum NA level and the ANP and ET-1 levels in fetal umbilical artery were compared. Results: The mean arterial pressure (MBP) and heart rate (HR) were decreased and similar between the two groups after 1 hour of labor analgesia.The VAS score at T1-T7 in both groups was decreased,and the decrease was more marked in the test group at T2-T7 ( P <0.05).There were no significant differences in the duration of labor analgesia,device midwifery rate and cesarean section rate as well as the neonatal Apgar scores at 1 min and 5 min between the two groups ( P >0.05).Pregnant women in the test group used less epidural drugs and experienced a shorter second stage of labor ( P <0.05).After 1 hour of labor analgesia,the plasma NA level was decreased in both groups,and it was lower in the test group compared with the control group ( P <0.05).Moreover,the levels of ANP and ET-1 in fetal umbilical artery in the test group were significantly higher than those in the control group ( P <0.05). Conclusion: Dexmedetomidine combined with PIEB labor analgesia could reduce the NA level in pregnant women and elevate ANP and ET-1 levels in fetal umbilical artery,thereby regulating the arterial blood supply to the placenta.