硬膜外提前镇痛对产妇血清皮质醇、内皮素⁃1、一氧化氮的影响

The effect of early epidural analgesia on the serum cortisol,endothelin⁃1 and nitric oxide of parturients

目的观察进入产程时实施硬膜外提前镇痛对产妇血清皮质醇(COR)、内皮素⁃1(ET⁃1)与一氧化氮(NO)的影响。方法根据产妇自愿申请原则,将符合纳入标准的产妇分为提前镇痛组(P组)与对照组(C组),P组在进入产程时给予镇痛,C组不给予任何镇痛措施,两组分别在进入产程时(T0),宫口开全时(T1)与胎儿娩出后(T2)评估VAS疼痛评分与采取产妇静脉血3 mL,检测COR、ET⁃1值及NO浓度,记录产程时长、分娩方式,在胎儿娩出后即采取脐动脉血,记录其PO_(2)、PaCO_(2)、pH值。结果P组第一产程、第二产程、总产程较C组延长(P<0.05);随着产程进展P组在T1、T2时刻的VAS评分、COR含量较C组低(P<0.05),同时P组在T1、T2时刻ET⁃1水平较C组低(P<0.05),NO水平较C组高(P<0.05),两组新生儿Apgar评分、PO_(2)、PaCO_(2)、pH值比较差异无统计学意义(P>0.05)。结论提前实施硬膜外镇痛是可行的,不影响产妇及新生儿结局,且能减少疼痛对产妇的应激反应,有益于胎盘循环与胎盘灌注。

Objective To investigate the effect of premature epidural analgesia during labor on maternal serum cortisol(COR),endothelin⁃1(ET⁃1)and nitric oxide levels(NO).Methods According to the principle of voluntary application by the parturients,the parturients who met the inclusion criteria were divided into an early analgesia group(group P)and a control group(group C).When group P went into labor,they were given analgesia,whereas group C was not given any analgesia measures.The two groups were evaluated for VAS pain score at the time of labor(T0),full uterine opening(T1),and after delivery(T2),and 3mL of maternal venous blood was taken to detect COR,ET⁃1 and NO concentrations as well as record the labor process Duration,delivery method,umbilical artery blood is taken immediately after the fetus is delivered,and its PO_(2),PaCO_(2),and pH values are recorded.Results The first,second,and total stages of labor in group P were longer than those in group C(P<0.05);as labor progressed,the VAS score and COR content in group P at T1 and T2 were lower than those in group C(P<0.05).At the same time,the ET⁃1 level of group P was lower than that of group C at T1 and T2(P<0.05),and the level of NO was higher than group C(P<0.05).There was no statistical comparison of the two groups of newborns′Apgar scores,PO_(2),PaCO_(2),and pH values.Academic distinction(P>0.05).Conclusion It is feasible to implement epidural analgesia ahead of time,it has no effect on maternal or neonatal outcomes,and it can reduce the maternal stress response to pain,which is beneficial to placental circulation and perfusion.