硬膜外分娩镇痛后产时发热产妇血清IL-6、HSP70表达变化的临床研究

Clinical study on the changes of serum IL-6 and HSP 70 expression in women with labor fever after epidural labor analgesia

目的从产妇血清白细胞介素(IL)-6、热休克蛋白70(HSP70)水平变化探讨硬膜外分娩镇痛后产时发热的发生原因。方法选择硬膜外分娩镇痛后经阴道分娩的单胎头位初产妇60例,根据硬膜外分娩镇痛后第一产程中体温是否≥37.6℃分为发热组(28例)和正常体温对照组(32例)。比较两组产妇年龄、体重、身高、体重指数、孕周等一般资料;记录硬膜外分娩镇痛前(T_(1))、硬膜外分娩镇痛2 h、宫口开全时(T_(2))的视觉模拟评分法(VAS)疼痛评分,硬膜外分娩镇痛时长,破水至分娩时长及第一产程、第二产程和第三产程时长;记录宫颈内口检查次数、羊水污染率、抗生素使用率、产时出血量、会阴侧切率和产钳使用率等分娩结局指标;记录新生儿出生体重,出生1、5、10 min时Apgar评分及脐动脉血pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2));采用酶联免疫吸附测定(ELISA)法检测T_(1)、T_(2)和产后24 h(T_(3))产妇血清IL-6、HSP70水平。结果两组产妇年龄、体重、身高、体重指数、孕周等一般资料,T_(1)、硬膜外分娩镇痛2 h、T_(2)时的VAS疼痛评分,破水至分娩时长,第一产程、第二产程和第三产程时长等比较,差异均无统计学意义(均P>0.05)。两组产妇硬膜外分娩镇痛2 h时和T_(2)时的VAS疼痛评分较T_(1)时均降低(均P<0.05)。发热组产妇硬膜外分娩镇痛时长、羊水污染率、抗生素使用率、会阴侧切率高于对照组(均P<0.05)。两组产妇宫颈内口检查次数,产时出血量,产钳使用率,新生儿出生体重,出生1、5、10 min时Apgar评分及脐动脉血pH值、PaO_(2)、PaCO_(2)等比较,差异均无统计学意义(均P>0.05)。T_(2)时,发热组产妇血清IL-6水平高于对照组(P<0.05),两组产妇血清IL-6水平高于T_(1)和T_(3)时(均P<0.05)。T_(2)时,对照组产妇血清HSP70水平高于T_(1)和T_(3)时(均P<0.05),发热组产妇血清HSP70水平高于T_(3)时(P<0.05)。结论感染不是硬膜外分娩镇痛后产时发热的主要病因,多种因素参与诱发的无菌性炎症反应可能是最主要的发生机制。

ObjectiveTo investigate the causes of labor fever after epidural labor analgesia from the changes of maternal serum interleukin(IL)-6 and heat shock protein 70(HSP70)expression.MethodsA total of 60 singleton primigravid women with cephalic position who were delivered vaginally after epidural labor analgesia were selected.According to whether their body temperature was≥37.6℃during the first stage of labor after epidural labor analgesia,they were divided into two groups:a fever group(n=28)and a normal body temperature control group(n=32).Both groups were compared for general data such as age,weight,height,body mass index,and gestational age.Their Visual Analog Scale(VAS)scores before epidural labor analgesia(T_(1)),after 2 h of epidural labor analgesia,and at the time of opening of the uterine orifice(T_(2)),as well as the duration of epidural labor analgesia,the duration of the period from water breaking to delivery,and the duration of the first stage of labor,the second stage of labor and the third stage of labor were recorded.Furthermore,delivery outcome indicators such as the number of endocervical examinations,the rate of amniotic fluid contamination,the rate of antibiotic use,blood loss during labor,the rate of perineal lateral incision and the rate of forcep use were recorded.Newborn birth weight,Apgar scores at 1,5 min and 10 min after birth and umbilical artery blood pH value,arterial blood partial pressure of oxygen(PaO_(2))and arterial blood partial pressure of carbon dioxide(PaCO_(2))were recorded.The levels of maternal serum IL-6 and HSP70 at T_(1),T_(2)and postoperative 24 h(T_(3))were measured by enzyme-linked immunosorbent assay(ELISA).ResultsThere was no difference between the two groups in terms of general information such as age,weight,height,body mass index and gestational age,as well as VAS scores at T_(1),after 2 h of epidural labor analgesia,and T_(2),and the duration of the period from water breaking to delivery,the duration of the first stage of labor,the second stage of labor,and the third stage of labor(P>0.05).Both groups showed decreases in VAS scores at 2 h of epidural labor analgesia and at T_(2),compared with those at T_(1)(both P<0.05).The fever group presented increases in the duration of maternal epidural labor analgesia,the rate of amniotic fluid contamination,the rate of antibiotic use,and the rate of perineal lateral incision,compared with the control group(P<0.05).No statistical differences were found as to the number of endocervical examinations,blood loss during labor,the rate of forcep use,newborn birth weight,Apgar scores at 1,5 min and 10 min after birth and the pH value of umbilical artery blood,PaO_(2),and PaCO_(2)between the two groups(P>0.05 for all of them).At T_(2),the fever group showed higher levels of serum IL-6 than the control group(P<0.05),and the levels of serum IL-6 in both groups were higher than those at T_(1)and T_(3)(both P<0.05).At T_(2),the levels of maternal serum HSP70 in the control group were higher than those at T_(1)and T_(3)(both P<0.05),and the levels of maternal serum HSP70 in the fever group were higher than those at T_(3)(P<0.05).ConclusionsInfection is not the main cause of labor fever after epidural labor analgesia,and aseptic inflammatory response induced by multiple factors may be the main mechanism.