硬膜外分娩镇痛对妊娠期高血压疾病产妇应激反应及肾功能的影响

Effect of epidural labor analgesia on stress response and renal function in pregnant women with pregnancy-induced hypertension

目的评价硬膜外分娩镇痛对妊娠期高血压疾病产妇应激反应及肾功能的影响。方法选择2018年7月至2019年7月在包钢集团第三职工医院经阴道分娩的妊娠期高血压疾病产妇80例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄范围为22~35岁,初产;足月;单胎,头位。采用随机数字表法将病人分为妊娠期高血压疾病未行任何分娩镇痛组(对照组)和妊娠期高血压疾病行硬膜外分娩镇痛组(观察组),每组40例。记录产妇宫口开至2 cm(T1)、4 cm(T2)、10 cm(T3)时的平均动脉压、心率及视觉模拟(VAS)评分;记录新生儿出生后1 min、5 min时的Apgar评分;记录产妇宫口开至2 cm、10 cm及胎儿娩出后(T4)的血糖浓度和皮质醇水平;记录产妇产前(T5)和产后(T6)肌酐、尿素、尿酸及血清胱抑素C的水平。结果产妇宫口开至4和10 cm时观察组平均动脉压[(94.09±8.43)mmHg比(106.35±8.88)mmHg和(103.42±10.84)mmHg比(108.01±9.02)mmHg]、心率[(82.18±9.16)次/分比(86.70±8.64)次/分和(87.07±7.55)次/分比(91.20±8.55)次/分]及VAS评分[(1.24±1.21)分比(8.80±0.90)分和(5.98±2.30)分比(9.56±0.22)分]低于对照组(P<0.05)。产妇宫口开至10 cm及胎儿娩出后观察组的血糖浓度和皮质醇水平低于对照组(P<0.05)。对照组产后血清胱抑素C水平与产前相比升高,而观察组产后血清胱抑素C水平与产前相比降低(P<0.05)。结论硬膜外分娩镇痛可降低分娩过程中疼痛评分,减轻妊娠期高血压疾病病人分娩过程中的应激反应,对循环及肾功能的影响较小,可提高妊娠期高血压疾病产妇分娩过程中的安全性。

Objective To evaluate the effects of epidural labor analgesia on stress response and renal function in patients with hypertensive disorder complicating pregnancy.Methods Eighty women with gestational hypertension syndrome who underwent vaginal delivery in The Third Staff Hospital of Baotou Steel Group from July 2018 to July 2019 were selected.The American Society of Anesthesiol⁃ogists(ASA)gradeⅠorⅡ,age 22-35 years old,primiparous,full-term,single birth,head position.Patients were assigned into 2 groups(n=40):no analgesia pregnancy with hypertensive group(observation group)and pregnancy-induced hypertension epidural labor analge⁃sia group(control group).The mean arterial pressure,heart rate and VAS scores at 2 cm(T1),4 cm(T2),and 10 cm(T3)were recorded.The Apgar scores at 1 min and 5 min after birth were recorded.The maternal cervix was opened to 2 cm,10 cm,and the blood glucose concentration and cortisol level after fetal delivery(T4),the levels of creatinine,urea,uric acid and serum cystatin C in maternal prena⁃tal(T5)and postpartum(T6)were recorded.Results The mean arterial pressure[(94.09±8.43)mmHg vs.(106.35±8.88)mmHg and(103.42±10.84)mmHg vs.(108.01±9.02)mmHg],heart rate[(82.18±9.16)times/min vs.(86.70±8.64)times/min and(87.07±7.55)times/min vs.(91.20±8.55)times/min]and VAS scores[(1.24±1.21)scores vs.(8.80±0.90)scores and(5.98±2.30)scores vs.(9.56±0.22)scores]of control group were lower than those of observation group when the mother's cervix was opened to 4 and 10 cm(P<0.05).The blood glucose concentration and cortisol level in the control group were lower than those in the observation group(P<0.05).The postpartum serum cystatin C level in observation group was higher than that in prenatal period,while the postpartum serum cystatin C level in control group was lower than that in prenatal period(P<0.05).Conclusion Epidural labor analgesia can reduce the pain score during childbirth,reduce the stress response during the delivery of hypertensive disorder complicating pregnancy,and have less influence on circulation and renal function,which can improve the safety of pregnant women with pregnancy-induced hypertension during delivery.