硬膜外分娩镇痛对孕妇和胎儿内分泌功能的影响  

The effect of epidural labor analgesia on the endocine function of gravida and fetus

作　　者：戴培静[1] 刘海林[1] 

机构地区：[1]南京医科大学附属淮安市第一医院,淮安223300

出　　处：《南通大学学报（医学版）》2006年第1期21-22,25,共3页Journal of Nantong University(Medical sciences)

摘　　要：目的:观察硬膜外分娩镇痛对孕妇和胎儿内分泌功能的影响。方法:选择50例ASA I-II级,单胎足月初产妇,随机平分为镇痛组(A组)和未实施镇痛组(B组)。两组孕妇在宫口开放3 cm时(T1)、宫口开放60m in时(T2)和胎儿娩出时刻(T3),抽取外周静脉血。在T3时抽取脐血和羊水,用酶ELISA和放射免疫分析法测定促肾上腺皮质激素释放激素(CRH)、皮质醇和前列腺素E2的浓度。对孕妇进行视觉模拟平分(VAS),对新生儿进行Apgar评分。结果:A组T2和T3时刻VAS评分低于B组(P<0.05)。两组新生儿Apgar评分无统计学意义。两组各时刻外周血、脐血和羊水CRH浓度无统计学意义(P>0.05)。T2和T3时刻A组皮质醇浓度低于B组(P<0.05);而脐血和羊水的皮质醇浓度无统计学意义(P>0.05)。各时刻外周血、脐血和羊水PGE2浓度无统计学意义。结论:硬膜外分娩镇痛可以达到较好的镇痛效果,减轻孕妇的应激反应,而对胎盘一胎儿内分泌功能无影响。Objective ： To observe the effect of epidural labor analgesia on the endocrine function of placenta - fetus. Methods ： Fifty full- term primiparous patuarients with SAS physical status Ⅰ and Ⅱ were randomly divided into Group A in which epidural analgesia was performed ,and Group B in which no epidural analgesia was carriet out. Albow venous blood was drawn from each parturient in 3cm cervical dilation（ T1 ） ,3cm cerical dilation after 60min（ T2 ） and fetal disengagerment（ T3 ）. In addition, umbilical vein blood and amniotic fluid after delivery were collected. The RIA and ELISA method were used to measure CRH, cortisol,PGE2. VAS sores and Apgar＇s score were recorded. Results：At T2 and T3 ,VAS scores in group A were lower than that of group B（ P 〈0.05）. There was no difference in Apgar＇s score of both groups. The concentration of CRH was similar in venous blood umbilical vein blood and amniotic fluid（ P 〉 0.05 ）. Compared with group B ,the concentration of cortisol in maternal blood decreased after epideural analgesia in group A. However,it is similar in umbilical vein blood blood decreased after epidural analgesia in group A. However,it is simial in umbilical vein blood and amniotic fluid in two groups. The concentration of PGE2 was also similar in maternal blood,in umbilical vein blood and amniotic fluid in two groups. Conclusion ： Epidural labor analgesia has an good effect on labor pain and inhibits stress of gravida. Hovwever,it has no effect on the placenta - feutes.

关 键 词：硬膜外 皮质激素释放激素 皮质醇 前列腺素E2 孕妇 胎儿 

分 类 号：R614.42[医药卫生—麻醉学]