PIEB复合PCEA镇痛对分娩结局及Th1/Th2型细胞因子影响

Influences of PIEB combined with PCEA for labor analgesic on Th1/Th2 Cytokine level and delivery outcomes

目的:探讨程控硬膜外间歇脉冲注入(PIEB)复合硬膜外自控镇痛(PCEA)对产妇分娩结局及Th1/Th2型细胞因子平衡的影响。方法:2016年1月-2017年12月本院收治的孕妇216例,随机分为PIEB组、PCEA组和复合组各72例,PIEB组采取硬膜外混合药剂(0.125%布比卡因+0.4μg/ml舒芬太尼)10ml/脉冲,1个脉冲/h给药,PCEA组采取产妇自控按键给药,复合组以8ml/h持续脉冲给药同时产妇自控追加药量。检测血清皮质醇、IL-1β、IL-10水平;记录潜伏期末(T1)、宫口开全、胎儿娩出(T2)时VAS评分;记录产程、新生儿Apgar评分;统计分娩结局及缩宫素使用。结果:实施镇痛后PIEB组、复合组布比卡因及舒芬太尼用药量以及宫口全开、T2时VAS评分均低于PCEA组(P<0.05);复合组第一产程活跃期、第二产程短于另外两组,T2时各组血清皮质醇、IL-1β、IL-10水平均低于T1时,复合组血清皮质醇、IL-1β水平低于另外两组、血清IL-10水平高于另外两组(均P<0.05);复合组阴道顺产率、满意率最高,分娩采取阴道器械助产率、缩宫素使用率最低(P<0.05)。结论:PIEB复合PCEA分娩镇痛模式在减轻产妇分娩疼痛、缩短第一产程活跃期与第二产程、降低器械助产率均更佳,在一定程度上维持Thl/Th2型细胞因子平衡,提高产妇分娩镇痛质量。

Objective:To investigate the influences of programmed intermittent epidural bolus(PIEB)combined with patient-controlled epidural analgesia(PCEA)on Th1/Th2 Cytokine level and delivery outcomes of pregnant women.Methods:216 pregnant women were randomly divided into group A(72 women were given PIEB only),group B(72 women were given PCEA only),and group C(72 women were given PIEB combined with PCEA)from January 2016 to December 2017.All women were injected into epidural mixture(0.125% Bupivacaine+0.4μg/ml Sufentanil).Women in group A were treated by PIEB(epidural mixture 10 ml/pulse,1 pulse/h),women in group B were treated by PCEA,and women in group C were treated by PIEB(epidural mixture 8 ml/h,1 pulse/h)combined with PCEA.The levels of serum cortisol,IL-1βand IL-10 were detected.VAS score of women at the end of latent period(T1),the mouth of the uterus completely opening(T2),and fetal delivery(T3)were recorded.The stage of labor,neonatal Apgar score,the delivery outcomes,and oxytocin usage of women were compared between the two groups.Results:After analgesia,the dasage of Bupivacaine and Sufentanil,the VAS scores at T2 and T3 of women in group A and group C were significant lower than those of women in group B(P<0.05).The active period time of the first stage and time of second stage of women in group C were significant shorter than those of women in group A and C(P<0.05).The levels of serum cortisol,IL-1βand IL-10 of all women in the three groups at T1 were significant lower than those of women at T3(P<0.05).The levels of serum cortisol and IL-1βof women in group C were significant lower than those of women in group A and B,but the level of serum IL-10 of women in group C was significant higher(P<0.05).The rate of vaginal delivery or satisfaction of women in group C was highest,but the rate the vaginal device midwifery or oxytocin used when vaginal delivery was the lowest(P<0.05).Conclusion:PIEB combined with PCEA for labor analgesia can relieve labor pain,shorten the active period of the first stage and second stage of labor,and decrease the instrumental midwifery rate,and it also can improve the quality of labor analgesia by maintaining Thl/Th2 cytokine balance and obtain satisfactory results.