剖宫产术应用腰硬联合麻醉与硬膜外麻醉对妊娠高血压产妇应激反应及炎症因子影响

The influence of combined spinal-epidural anesthesia and epidural anesthesia during cesarean section of the women with pregnancy induced hypertension on their stress response and inflammatory factors levels

目的:探讨妊娠高血压产妇剖宫产中腰硬联合麻醉与硬膜外麻醉对产妇应激反应和炎症因子的影响。方法:选取2017年3月—2020年3月本院产科收治的120例行剖宫产手术的妊娠高血压孕妇,随机数字表分为观察组和对照组各60例。对照组采用单纯硬膜外麻醉,观察组采用腰硬联合麻醉。比较两组产妇麻醉前1h(T0)、手术结束时(T1)、术后24h(T2)血清皮质醇(Cor)、丙二醛(MDA)、超氧化物歧化酶(SOD)、总抗氧化能力(TAC)应激反应和超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)炎症因子指标变化。结果:两组产妇T0时HR、DBP、SBP、MAP血流动力学指标无差异(P>0.05)。T1时两组产妇HR、DBP、SBP、MAP均低于T0时,且观察低于对照组(P<0.05)。两组T0时血清Cor、MDA、SOD、TAC应激反应指标及hs-CRP、TNF-α、IL-6炎症因子均无差异(P>0.05)。T1、T2时两组产妇血清Cor、MDA、TAC及hs-CRP、TNF-α、IL-6水平均高于T0,SOD则低于T0(均P<0.05);T2时两组血清Cor、MDA、TAC及hs-CRP、TNF-α、IL-6水平均高于T1,SOD低于T1(均P<0.05)。T1、T2时观察组血清Cor、MDA、TAC及hs-CRP、TNF-α、IL-6水平均高于对照组,SOD水平低于对照组(均P<0.05)。结论:腰硬联合麻醉能更有效缓解妊娠高血压产妇剖宫产术麻醉中血流动力学指标,抑制应激反应和炎症因子释放,有助于麻醉及术后恢复。

Objective:To investigate the influence of combined spinal-epidural anesthesia and epidural anesthesia during cesarean section of the women with pregnancy induced hypertension on their stress response and inflammatory factors levels.Methods:A total of 120 pregnant women with pregnancy induced hypertension who underwent cesarean section were selected as the research subjects and were randomly divided into observation group and control group(60 cases in each group)by the random number table from March 2017 to March 2020.The women in the control group were treated with simple epidural anesthesia,while the women in the observation group were treated with combined spinal-epidural anesthesia.The changes of the levels of serum inflammatory factors indexes,such as cortisol(Cor),malondialdehyde(MDA),superoxide dismutase(SOD),total antioxidant capacity(TAC)stress response,high sensitivity C reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6),of the women at 1 h before anesthesia(T0),at the end of surgery(T1),and at 24 h after surgery(T2)of the women were compared between the two groups.Results:The values of hemodynamic indexes,such as HR,DBP,SBP,and MAP,of the women at T0 had no significant different between the two groups(P>0.05).At T1,the values of HR,DBP,SBP,MAP of the women in the two groups were significant lower than those of the women at T0,and those of the women in the observation were significant lower than those of the women in the control group(P<0.05).There were no significant differences in levels of serum Cor,MDA,SOD,TAC,hs-CRP,TNF-α,and IL-6 of the women between the two groups(P>0.05).At T1 and T2,the levels of serum Cor,MDA,TAC,hs-CRP,TNF-α,and IL-6 of the women in the two groups were significant higher than those at T0,while the SOD level at T1 and T2 were significant lower(all P<0.05).At T2,the levels of serum Cor,MDA,TAC,hs-CRP,TNF-α,and IL-6 of the women in the two groups were significant higher than those at T1,while the SOD level at T2 was significant lower(all P<0.05).At T1 and T2,the levels of serum Cor,MDA,TAC,hs-CRP,TNF-α,and IL-6 of the women in the observation group were significant higher than those of the women in the control group,while the SOD level of the women in the observation group was significant lower(all P<0.05).Conclusion:Combined spinal-epidural anesthesia during cesarean section of the women with pregnancy induced hypertension can more improve the hemodynamic indicators of the women,inhibit the stress response and the release of inflammatory factors effectively,which is conducive to their anesthesia and postoperative recovery.