硬膜外分娩镇痛对母儿COR及IL-6等水平的影响  

Effects of epidural labor analgesia on serum levels of cortisol, interleukins-6 of mother and neonate

作　　者：周颖[1] 王莉[1] 丁秀菊[2] 

机构地区：[1]宝鸡市妇幼保健院,陕西宝鸡721000 [2]西安交通大学第一附属医院,陕西西安710061

出　　处：《中国妇幼健康研究》2010年第6期792-794,共3页Chinese Journal of Woman and Child Health Research

基　　金：宝鸡市卫生局资助项目（2009-23）

摘　　要：目的 观察硬膜外分娩镇痛对母儿血清皮质醇、白介素-6和一氧化氮水平的影响,探讨硬膜外分娩镇痛对产妇和新生儿应激反应的调控作用.方法 选择初产妇40例,随机分为镇痛组和对照组各20例,分别于分娩前、宫口开至3～4cm、宫口开全时和胎儿娩出后2小时4个时间点采集静脉血,并于胎儿娩出后采集脐静脉血,测定血清皮质醇、白介素-6和一氧化氮的浓度,持续监测分娩过程中产妇血流动力学、血氧饱和度及胎儿胎心率的变化情况.结果 与分娩前相比,随着产程的进展,两组血清皮质醇、白介素-6显著增高（t分别为4.230、7.726,均P〈0.05）,而一氧化氮则明显下降（t=3.538,P〈0.05）;在宫口开全、胎儿娩出后2小时血清皮质醇、白介素-6镇痛组显著低于对照组（t分别为5.180、7.712;18.261、6.520,均P〈0.05）,而一氧化氮显著高于对照组（t分别为8.922、7.726,均P〈0.01）.新生儿脐带血皮质醇、白介素-6镇痛组显著低于对照组（t分别为31.022、49.642,均P〈0.05）,一氧化氮则高于对照组（t分别为26.427,均P〈0.01）.结论 硬膜外分娩镇痛可稳定产程中产妇血清皮质醇、白介素-6和一氧化氮的水平,能有效地调控分娩时的应激反应.Objective To investigate effects of epidural labor analgesia on serum levels of cortisol （ COR）, interleukins-6 （ IL-6 ） and nitric oxide（NO） of mother and neonate, and to explore regulatory effect of epidural labor analgesia on stress responses of mother and neonate. Methods 40 primiparae were randomly divided into analgesia group（ n = 20） and control group（ n = 20）. The primiparae in analgesia group were given epidural analgesia during labor and those primiparae in control group were not given any analgesics. Blood samples were taken from mother vein at 4 time points： before anaesthesia （TO ）, at cervical dilation at 3-4 cm （T1）, at full cervical dilation （T2 ） and at 2h postpartum （T3 ）. Neonatal blood samples were taken at birth（ cord vein blood）. The serum levels of COR, IL-6 and NO of the mother and the neonate were detected. Changes in maternal hematodynamics, degree of blood oxygen saturation and fetal heart rate during labor process were monitored continuously. Results With prolongation of labor process, the serum levels of COR and IL-6 in the two groups were increased gradually and significantly at T1, T2 and T3 as compared with those at TO （t = 4. 230, 7. 726 respectively, both P 〈 0.05）, while the serum level of NO was significantly decreased （t = 3. 538, P 〈 0.05）. The serum levels of COR and IL-6 of the neonate at T2 and T3 were significantly lower than those in the control group, there were significant differences between the two groups（ t = 31. 022, 49. 642 respectively, both P 〈 0.01 ）, while the serum levels of NO at T2 and T3 were significantly higher than in the control group （ t = 26.427, P 〈0.01 ）. Conclusion Epidural labor analgesia can alleviate maternal stress response induced by labor and lower serum levels of COR and IL-6 of mother and neonate and increase their serum levels of NO.

关 键 词：分娩镇痛 应激 皮质醇 白介素-6 一氧化氮 

分 类 号：R714[医药卫生—妇产科学]