不同时期硬膜外全程镇痛对母婴血清皮质醇、内皮素-1和一氧化氮的影响  

The effect of epidural analgesia at different stages on maternal and infant serum cortisol,endothelin-1 and nitric oxide

作　　者：马欢欢 李国琴[1] 王健[1] 刘晓欧[1] MA Huan-huan;LI Guo-qin;WANG Jian;LIU Xiao-ou(Department of Anesthesiology,Zunyi Maternal and Child Healthcare Hospital,Zunyi 563000,Guizhou,China)

机构地区：[1]遵义市妇幼保健院麻醉科,贵州遵义563000

出　　处：《广东医学》2020年第3期238-242,共5页Guangdong Medical Journal

基　　金：遵义市科技计划项目(遵市科合社字(2018)205号)。

摘　　要：目的观察母婴不同时期硬膜外全程镇痛血清皮质醇(COR)、内皮素-1(ET-1)和一氧化氮(NO)水平的变化,探讨不同时期镇痛对胎盘灌注的影响。方法根据纳入标准,采用自愿原则,信封随机将患者分为潜伏期镇痛组与活跃期镇痛组,每组100例,分别于1 cm≤宫口<3 cm与宫口≥3 cm时实施硬膜外镇痛,记录第一、二产程时长、分娩方式,分别在实施镇痛前(T0)、宫口开全(T1)与娩出胎儿(T2)时刻评估VAS疼痛评分,同时在不同时刻抽取产妇静脉血及娩出新生儿后采取脐动脉血用酶联免疫法检测COR、ET-1值,用硝酸还原酶法测定NO浓度,记录其含量与脐动脉血气分析。结果经过不同时期镇痛后,两组产妇VAS评分、新生儿Apgar评分组间比较差异均无统计学意义(P>0.05),活跃期镇痛组产妇在T2时刻的COR浓度较潜伏期镇痛组高,差异有统计学意义(P<0.05),NO含量却较潜伏期镇痛组低,差异有统计学意义(P<0.05),活跃期镇痛组娩出的新生儿脐动脉血COR含量较潜伏期镇痛组高,差异有统计学意义(P<0.05)。结论硬膜外全程镇痛能有效调控应激反应,且潜伏期镇痛组胎盘灌注较活跃期镇痛组更佳。Objective To observe the changes of serum cortisol(COR),endothelin-1(ET-1)and nitric oxide(NO)levels in different periods of epidural analgesia,and to investigate the effects of different periods of analgesia on placental perfusion.Methods The eligible parturient women were enrolled in this controlled and prospective clinical trial,and randomly assigned to latent analgesia group and active analgesia group;in which epidural analgesia was given when the cervical dilation between 1 cm and 3 cm and above 3 cm,respectively.The data of the duration of the first stage and second stage of labor and the delivery methods were recorded.The VAS pain score was evaluated before anesthesia(T0),full dilation(T1)and delivery(T2).The venous blood of parturient and umbilical artery blood were collected.Results There was no significant difference between the two groups in VAS score or Apgar score(P>0.05).The concentration of COR at T2 in active analgesia group was significantly higher than that in latent analgesia group(P<0.05),but the content of NO was significantly lower than that in latent analgesia group(P<0.05).Conclusion The whole course epidural analgesia can effectively alleviate the stress response,and latent analgesia is superior in improving the placental perfusion than active analgesia.

关 键 词：分娩镇痛 皮质醇 内皮素-1 一氧化氮 

分 类 号：R714.3[医药卫生—妇产科学] R614.4[医药卫生—临床医学]