不同时期硬膜外全程镇痛对母婴血清皮质醇的影响

Effect of Total Epidural Analgesia in Different Periods on Serum Cortisol of Mother and Infant

目的观察不同时期硬膜外全程镇痛对母婴血清皮质醇的影响,探讨不同时期镇痛对母婴应激反应的变化。方法符合纳入标准的产妇,信封随机分为潜伏期镇痛组与活跃期镇痛组,每组100例,分别于1 cm≤宫口<3 cm与宫口≥3 cm时实施硬膜外镇痛,记录产妇VAS评分、第一、二产程时长,分娩方式、新生儿的Apgar评分,分别在实施镇痛前(T0)、第一产程结束时(T1)与第二产程结束时(T2)评估VAS评分同时抽取产妇静脉血,新生儿娩出后采取脐动脉血用酶联免疫法检测COR含量。结果两组产妇T1、T2时刻VAS评分较T0时刻低(P<0.05);第一、二产程时长、分娩方式比较差异无统计学意义(P>0.05);实施镇痛后,两组T1、T2时刻的COR浓度较镇痛前T0时刻低(P<0.05);两组新生儿的COR浓度、Apgar评分比较,差异无统计学意义(P>0.05)。结论潜伏期与活跃期硬膜外全程镇痛能有效减轻疼痛,调控应激反应。

Objective To observe the effect of epidural analgesia in different periods on maternal and infant serum cortisol,and to explore the changes in maternal and infant stress response during different periods of analgesia.Methods The parturients who met the inclusion criteria were randomly divided into the latent analgesia group and the active phase analgesia group,with 100 cases in each group.Epidural analgesia was performed when 1cm≤uterine cavity<3cm and uterine mouth≥3cm,respectively.VAS score,length of the first and second stages of labor,delivery method,Apgar score of the newborn,respectively before the implementation of analgesia(T0),at the end of the first stage of labor(T1)and at the end of the second stage of labor(T2)at the same time to evaluate the VAS score The venous blood of the parturient was drawn,and the umbilical artery blood was taken after delivery of the newborn to detect the COR content by enzyme-linked immunosorbent assay.Results The VAS score at T1 and T2 was lower than that at T0 in the two groups(P<0.05);there was no significant difference in the length of the first and second stages of labor and mode of delivery between the two groups(P>0.05);after the implementation of analgesia,the COR concentration at T1 and T2 in the two groups was lower than that at T0 before analgesia(P<0.05).There was no significant difference in COR concentration and Apgar score between the two groups(P>0.05).Conclusion Epidural analgesia in the incubation period and active period can effectively reduce pain and regulate stress response.