硬膜外分娩镇痛对产妇激素水平及产程的影响

Effects of epidural analgesia during labor on prostaglandin level and course of labor

目的 探讨硬膜外分娩镇痛对产妇前列腺素(PGE_(2))、催产素水平及产程进展的影响。方法 选择2022年3月至9月入大连医科大学附属第二医院待产的孕妇57例,据产妇意愿分为硬膜外分娩镇痛组(EA组)和未镇痛组(C组)。EA组以罗哌卡因和舒芬太尼行硬膜外镇痛,C组自然分娩。设置时点T0(宫口开2 cm), T1(T0后1小时),T2(宫口开全),T3(第二产程结束),T0~T2时点取产妇外周静脉血10 mL, T3时点取羊水10 mL,测PGE_(2)、催产素水平,记录产程时间和各时点视觉模拟评分(VAS)。结果 最终EA组30例,C组20例产妇入组。两组产妇年龄、体重指数(BMI),新生儿体重、 Apgar评分差异无统计学意义。各时点PGE_(2)及催产素水平比较,差异无统计学意义,P> 0.05。两组第一、二产程时间差异无统计学意义,P> 0.05。两组T0时点VAS评分差异无统计学意义,P>0.05;EA组T1、T2时点VAS评分均低于C组,差异有统计学意义,P<0.01。结论 硬膜外分娩镇痛效果良好,对PGE_(2)分泌影响小,对产程无明显影响,是可靠的分娩镇痛方式。

Objective To study the effects of epidural analgesia during labor on the changes of maternal prostaglandin (PG) E_(2) and oxytocin levels and the course of labor, in order to help the clinical intervention of epidural analgesia during labor.Methods Fifty-seven pregnant women were selected, who were admitted to the Second Hospital of Dalian Medical University from March 2022 to September 2022. According to their wishes and consents to epidural analgesia, the patients were assigned in experimental group (EA group) or control group (C group). The patients in EA group received epidural analgesia with ropivacaine and sufentanyl and patient-controlled epidural analgesia (PCEA) was used during labor. The women in C group gave birth naturally. Data were collected at the following time points: T0, cervix dilation to 2 cm;T1, 1 hour after T0;T2, beginning of the second stage of labor, and T3, the end of the second stage of labor. At T0-T2 peripheral venous blood 10 mL were gathered, and at T3 amniotic fluid 10 mL were collected in both groups. The levels of PGE_(2) and oxytocin in blood and amniotic fluid were measured. The visual analogue scale (VAS) was also determined. The administration of the course of the first and second stages of labor were compared between the two groups.Results Totally, 30 women in group EA and 20 women in group C were enrolled. There were no significant differences in maternal age, body mass index (BMI), newborn weight and Apgar scores between the two groups, and the PGE_(2) and oxytocin levels were similar at T0, T1, T2, and T3 (P>0.05). There were no significant differences in the course of the first and second stages of labor between the two groups, P>0.05. While the VAS score was similar at T0 between the two groups (P>0.05), the scores of group EA at T1 and T2 were lower than those of group C, and the differences between the two groups were statistically significant (P<0.01).Conclusion Epidural analgesia has good analgesic effect during labor and has little effect on PGE_(2) secretion, oxytocin levels, and the labor process. It is a reliable analgesic method for labor.