腰麻联合硬膜外间歇脉冲输注对分娩产妇镇痛及脐带血GSH、β-Car的影响

The effect of lumbar anesthesia combined with intermittent epidural bolus on labor analgesia and umbilical cord blood GSH and β-Car levels

目的:探讨腰麻联合硬膜外间歇脉冲输注(IEB)镇痛对分娩产妇镇痛及脐带血还原型谷胱甘肽(GSH)、β-胡罗卜素(β-Car)的影响。方法:选取2017年1月至2018年1月河北省保定市妇幼保健院西院收治的160例足月产妇,按随机数字表法分为观察组和对照组,每组80例。对照组采用硬膜外麻醉后IEB,观察组采用腰麻联合IEB。比较两组麻醉效果、相关临床指标及不良反应发生情况。结果:观察组疼痛等级低于对照组,麻醉起效时间短于对照组,镇痛泵有效按压次数少于对照组(均P<0.05)。镇痛后30min、60min,观察组子宫收缩持续时间、子宫收缩间隔时间长于对照组(均P<0.05)。麻醉后5min(T2)、麻醉后15min(T3)时,观察组心输出量(CO)、平均动脉血压(MAP)、心脏指数(CI)、心率(HR)显著大于对照组(均P<0.05)。麻醉前(T1)及T2时,两组收缩期最大峰值流速与舒张末期流速比值(S/D)和阻力指数(RI)比较,差异无统计学意义(均P>0.05)。观察组脐带血还原型谷胱甘肽(GSH)和β-胡罗卜素(β-Car)水平高于对照组(均P<0.05)。T1时,两组IL-6和TNF-α水平无明显差异;手术结束(T5)时,两组IL-6和TNF-α水平均上升,且观察组低于对照组(均P<0.05)。两组新生儿异常情况发生率、不良反应发生率比较,差异无统计学意义(均P>0.05)。结论:腰麻联合IEB的镇痛效果优于硬膜外麻醉后IEB,并能升高脐带血GSH和β-Car水平,降低IL-6和TNF-α水平。

Objective:To explore the effect of lumbar anesthesia combined with intermittent epidural bolus(IEB)on labor analgesia and umbilical cord blood GSH andβ-Car levels.Methods:A total of 160 parturients in our hospital from January 2017 to January 2018 were selected and randomly divided into an observation and a control group,with 80 cases in each group.The parturients in the control group received IEB after epidural anesthesia,and those in the observation group received lumbar anesthesia combined with IEB.The anesthetic effect,related clinical indicators and the incidence of adverse reactions were compared between the two groups.Results:The pain grade,the onset time of anesthesia,and the number of effective compressions of analgesic pump in the observation group were lower than those in the control group(P<0.05).After 30 min and 60 min of analgesia,the duration and interval time of uterine contraction in the observation group were higher than those in the control group(P<0.05).The CO,HR,MAP and CI of the observation group were higher than those in the control group at 5 min(T2)and 15 min post-anesthesia(P<0.05).There was no significant difference on S/D and RI between the two groups at pre-anesthesia(T1)and T2(P>0.05).The GSH andβ-Car levels were higher in the observation group than that in the control group(P<0.05).No obvious difference in IL-6 and TNF-αlevels were noted between the two groups at T1.The IL-6 and TNF-αlevels were increased at the end of the surgery in both groups,and these indexes were lower in the observation group compared with the control group(P<0.05).There was no significant difference in the incidence of adverse reactions and neonatal situation between the two groups(P>0.05).Conclusion:Lumbar anesthesia combined with IEB had better analgesic effect than IEB after epidural anesthesia.