程控硬膜外间歇脉冲注入对产妇体温和血清Th1/Th2 型细胞因子的影响

Effect of programmed intermittent epidural bolus on maternal body temperature and serum T helper cells 1/T helper cells 2 cytokines

目的探讨程控硬膜外间歇脉冲注入(PIEB)对产妇体温和血清辅助性T细胞(Th)1/Th2型细胞因子的影响。方法选择2021年1月至2022年12月在沧州市人民医院待产拟行硬膜外分娩镇痛的初产妇198例,按随机数字表法分为观察组和对照组,每组99例。观察组硬膜外镇痛采用PIEB,对照组采用持续硬膜外输注(CEI),镇痛药物均为0.08%盐酸罗哌卡因注射液+0.4 mg/L枸橼酸舒芬太尼注射液+0.9%氯化钠注射液。记录产妇一般资料。记录并比较两组镇痛前(T_(1))和镇痛后1 h(T_(2))、2 h(T_(3))、3 h(T_(4))、4 h(T_(5))、5 h(T_(6))及胎儿娩出即刻(T_(7))时产妇视觉模拟评分法(VAS)疼痛评分、平均动脉压(MAP)、心率和胎心率,T_(1)~T_(7)及分娩后2 h(T_(8))时产妇发热情况。检测两组产妇T_(1)、T_(7)时血清Th1/Th2型细胞因子[肿瘤坏死因子‑α(TNF‑α)、白细胞介素(IL)‑1β、IL‑10]水平。比较两组产妇镇痛泵首次按压时间、按压次数、罗哌卡因用量和舒芬太尼用量,新生儿1 min、5 min Apgar评分,产妇各产程时间及使用缩宫素、产钳助产、会阴侧切、产后出血量>500 ml的情况、不良反应发生情况(皮肤瘙痒、低血压、尿潴留、恶心呕吐等)。结果与T_(1)时比较:T_(2)~T_(7)时两组产妇VAS疼痛评分较低(均P<0.05);T_(3)~T_(8)时对照组产妇MAP较低(均P<0.05),T_(3)~T_(6)及T_(8)时观察组产妇MAP较低(均P<0.05);T_(2)~T_(8)时两组产妇心率较低(均P<0.05);T_(2)~T_(6)时两组产妇胎心率较低(均P<0.05);T_(7)时两组产妇血清TNF‑α、IL‑1β水平较高(均P<0.05),IL‑10水平较低(均P<0.05)。与对照组比较:观察组产妇T_(3)~T_(7)时VAS疼痛评分较低(均P<0.05);T_(5)~T_(8)时发热率较低(均P<0.05);T_(7)时血清TNF‑α、IL‑1β水平较低(均P<0.05),IL‑10水平较高(P<0.05);镇痛泵首次按压时间较长(P<0.05),按压次数、罗哌卡因用量和舒芬太尼用量较少(均P<0.05);会阴侧切率较低(P<0.05)。其他指标两组产妇差异无统计学意义(均P>0.05)。结论PIEB应用于硬膜外分娩镇痛能有效提高镇痛效果,减少产妇产时发热,适度维持体内Th1/Th2型细胞因子平衡,并能减少麻醉镇痛药物用量,降低会阴侧切率。

Objective To investigate the application effect of programmed intermittent epidural bolus(PIEB)in labor analge‑sia and its influence on the levels of maternal body temperature,serum T helper cells(Th)1/Th2 cytokines and pain factors.Meth⁃ods A total of 198 primiparae who were expecting to undergo epidural labor analgesia in Cangzhou People's Hospital from January 2021 to December 2022 were selected and divided into the observation group and the control group according to random number table method,with 99 cases in each group.PIEB mode was used for epidural analgesia in the observation group,while continuous epidural in‑fusion(CEI)mode was used in the control group,the analgesic drugs were 0.08%ropivacaine hydrochloride injection+0.4 mg/L sufent‑anil citrate injection+0.9%sodium chloride injection.Record general information of maternal bady.Maternal Visual Analogue Scale(VAS)score,mean arterial pressure(MAP),heart rate,and fetal heart rate were compared between the two groups at the time points be‑fore analgesia(T_(1)),1 h(T_(2)),2 h(T_(3)),3 h(T_(4)),4 h(T_(5)),5 h(T_(6))after analgesia and immediately after delivery(T_(7)).Maternal body temper‑ature at T_(1)-T_(7)and 2 h(T_(8))after delivery and the levels of serum Th1/Th2 cytokines[tumor necrosis factor‑α(TNF‑α),interleukin(IL)‑1β,IL‑10]in T_(1)and T_(7)were detected.The first time of analgesic pump compression,the number of compression times,the total dosage of ropivacaine and sufentanil,and the Apgar score of newborns in 1 min and 5 min were compared between the two groups.Du‑ration of labor,use of oxytocin,forceps,lateral perineal incision,postpartum bleeding>500 ml,the occurrence of adverse reactions(skin pruritus,hypotension,urine retention,nausea,and vomiting,etc.)were compared between the two groups.Results Compared with the scores at T_(1):the VAS scores of the two groups were low at T_(2)-T_(7)(all P<0.05);the MAP of the control group was low at T_(3)-T_(8)(all P<0.05),and that of the observation group at T_(3)-T_(6)and T_(8)(all P<0.05);the heart rates of both groups were low at T_(2)-T_(8)(all P<0.05);at time points T_(2)‒T_(6),the fetal heart rate was low in both groups(all P<0.05);at the time point T_(7),the serum levels of TNF‑αand IL‑1βwere high(all P<0.05),and the serum levels of IL‑10 were low(all P<0.05).The VAS scores in the observation group were lower than the scores of the control group at T_(3)-T_(7)(all P<0.05).Compared with the control group,the fever rates of observation group were low at T_(5)-T_(8)(all P<0.05).At time point T_(7),the serum levels of TNF‑αand IL‑1βof patients in the observation group were lower than the levels in the control groups(all P<0.05),whereas serum levels of IL‑10 in patients of the observation group were higher than the levels in the control group(P<0.05).The average first compression time of the analgesic pump in the observation group was later than the time of the control group(P<0.05),while the average number of compression times,and the dosage of ropivacaine and sufentanil of the observation group were less than the parameters of the control group(all P<0.05).The lateral resection rate of the perineum in the observation group was also lower than the rate of the control group(P<0.05).There were no significant difference in other indexes between the two groups(all P>0.05).Conclusions PIEB mode applied to epidural labor analgesia can effectively improve the analgesic effect,re‑duce maternal fever during childbirth,moderately maintain the balance of Th1/Th2 cytokines in the body,decrease the dosage of nar‑cotic analgesic drugs,and reduce the rate of lateral perineal incision.