分娩镇痛仪对分娩镇痛产妇氧化应激及疼痛介质水平的影响

Effect of labor analgesia instrument on the levels of oxidative stress and pain mediators in parturient receiving labor analgesia

目的:研究分娩镇痛仪对分娩镇痛产妇的氧化应激及疼痛介质水平的影响。方法:选取在医院分娩的130例产妇,按照抽签方式将其随机分为观察组和常规组,每组65例。常规组行常规硬膜外麻醉模式分娩镇痛,观察组采用分娩镇痛仪进行分娩镇痛,比较两组第一产程时间、第二产程时间、第三产程时间、产后出血量及转剖宫产率,以及分娩控制感量表(LAS)评分和疼痛视觉模拟(VAS)评分,比较两组分娩前后氧化应激指标[谷胱甘肽(GSH)、丙二醛(MDA)、超氧化物歧化酶(SOD)]和疼痛介质参数[P物质(SP)、前列腺素E2(PGE2)、5-羟色胺(5-HT)],比较两组新生儿指标[动脉血糖(BG)、碳酸氢根(HCO3)、血氧分压(PO_(2))、体重水平及1 min阿氏(Apgar)评分]及不良妊娠结局发生率。结果:观察组转剖宫产率为3.08%,常规组为7.69%,组间差异无统计学意义。观察组第一产程时间、第二产程时间及产后出血量显著低于常规组,LAS评分显著高于常规组,差异有统计学意义(t=2.263,t=3.606,t=2.241,t=5.958;P<0.05);观察组分娩后GSH、SOD显著低于分娩前,MDA显著高于分娩前,差异有统计学意义(t=10.163,t=5.207,t=9.519;P<0.05);观察组分娩后GSH、SOD高于常规组,MDA低于常规组,差异有统计学意义(t=4.063,t=3.773,t=3.825;P<0.05),观察组分娩后SP、PGE2及5-HT水平显著低于分娩前,差异有统计学意义(t=26.404,t=25.361,t=14.460;P<0.05);分娩后观察组SP和PGE2水平均低于常规组,差异有统计学意义(t=4.332,t=2.261;P<0.05),两组新生儿BG、HCO_(3)、PO_(2)、体重、1minApgar评分等指标比较差异无统计学意义,观察组不良妊娠结局总发生率为12.31%,常规组不良妊娠结局总发生率为16.92%,差异无统计学意义。结论:分娩镇痛仪可通过调节产妇氧化应激及疼痛介质表达来实现分娩镇痛效果,临床应用价值较高。

Objective: To study the effects of labor analgesia instrument on the levels of oxidative stress and pain mediators of parturient who received labor analgesia. Methods: A total of 130 parturient in hospital were selected and they were randomly divided into observation group and convention group by drawing lots, with 65 cases in each group.The convention group received conventional epidural anesthesia mode for labor analgesia, and the observation group received labor analgesia instrument for labor analgesia. The times of the first stage of labor, the time of the second stage of labor, the time of the third stage of labor, the amount of postpartum bleeding and the rate of shifting cesarean section,as well as the score of the sense of control scale of labor(LAS) and the score of visual analogue scale(VAS) of pain were compared between the two groups. And then, the oxidative stress indexes [glutathione(GSH), malondialdehyde(MDA), superoxide dismutase(SOD)] and pain mediating parameters [Substance P(SP), prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT)] were compared between before and after delivery, and between the two groups. In addition, the neonatal indexes [arterial blood glucose(BG), bicarbonate(HCO3), blood oxygen partial pressure(PO_(2)),body weight and 1-minute Apgar score] and the incidence of adverse pregnancy outcomes were compared between the two groups. Results: The rate of shifting cesarean section was 3.08% in the observation group and that was 7.69%in the convention group, and there was no significant difference in that between the two groups. The time of the first stage of labor, the time of the second stage of labor and the amount of postpartum bleeding in the observation group were significantly lower than those in the convention group, and the LAS score of former was significantly higher than that in the convention group, and the differences of them between the two groups were statistically significant(t=2.263,t=3.606, t=2.241, t=5.958, P<0.05), respectively. GSH and SOD in observation group after delivery were significantly lower than those before delivery, and MDA was significantly higher than that before delivery, the differences of them were statistically significant(t=10.163, t=5.207, t=9.519, P<0.05), respectively. After delivery, GSH and SOD in observation group were significantly higher than that in convention group, while MDA was significantly lower than that in convention group, and the differences of them were statistically significant(t=4.063, t=3.773, t=3.825,P< 0.05), respectively. The levels of SP, PGE2 and 5-HT in the observation group after delivery were significantly lower than those before delivery, and the differences of them were statistically significant(t=26.404, t=25.361,t=14.460, P<0.05), respectively. After delivery, the levels of SP and PGE2 in the observation group were significantly lower than those in the convention group, and the differences of them were statistically significant(t=4.332, t=2.261,P<0.05), respectively. There were no statistically significant differences in BG, HCO3, PO_(2), body weight, 1min Apgar score and other indicators between the two groups. The total incidence of adverse pregnancy outcome was 12.31%in the observation group and that was 16.92% in the convention group, and there was not statistically significant difference between the two groups. Conclusion: Labor analgesia instrument can achieve analgesia effect for labor by regulating oxidative stress and expression of pain mediators, which has higher value of clinical application.