硬膜外分娩镇痛对母婴血清COR、ET-1、神经行为与胎盘灌注的影响  

Effect of epidural labor analgesia on maternal and neonatal serum COR,ET-1,neurobehavior and placental perfusion

作　　者：阚炯 汪胜友 金文然 许可 KAN Jiong;WANG Sheng-you;JIN Wen-ran(Department of Anesthesiology,Maternal and Child Health Hospital of Anhui Province,Hefei Anhui 230000,China)

机构地区：[1]安徽省妇幼保健院麻醉科,安徽合肥230000

出　　处：《临床和实验医学杂志》2021年第13期1440-1443,共4页Journal of Clinical and Experimental Medicine

基　　金：安徽省科技厅年度重点项目(编号:1301043031)。

摘　　要：目的探究硬膜外分娩镇痛后母婴血清皮质醇(COR)、内皮素-1(ET-1)水平变化情况,分析其对产妇神经行为与胎盘灌注的影响。方法前瞻性选取2019年1月至2019年12月安徽省妇幼保健院收治的产妇96例作为研究对象,采用随机数字表法将其分为观察组48例和对照组48例,观察组实施硬膜外分娩镇痛,对照组不予以镇痛药,按常规分娩处理。比较2组产妇潜伏期(T1)、活跃期(T2)、胎儿娩出时(T3)及新生儿血清COR、ET-1水平;采用Bromage评分评价产妇不同时期神经行为变化情况;比较2组疼痛视觉模拟量表(VAS)评分,并统计有无不良反应及并发症发生。结果2组产妇T1时间点血清COR水平比较,差异无统计学意义(P>0.05);观察组产妇T2、T3时间点血清COR水平为(613.67±122.23)、(586.46±91.52)ng/mL,显著低于对照组[(763.58±103.19)、(819.97±132.86)ng/mL],差异均有统计学意义(P<0.05)。2组产妇各时期血清中ET-1水平比较,差异无统计学意义(P>0.05)。观察组婴儿脐血中COR水平为(96.62±2.47)ng/mL,显著低于对照组[(103.96±3.72)ng/mL],差异有统计学意义(P<0.05),2组脐血中ET-1水平比较,差异无统计学意义(P>0.05)。2组神经行为比较差异无统计学意义(P>0.05)。T1时期,2组VAS评分比较,差异无统计学意义(P>0.05),T2、T3时间点,观察组VAS评分为(2.45±1.85)、(3.17±0.87)分,显著低于对照组[(7.06±1.07)、(8.67±0.94)分],差异均有统计学意义(P<0.05)。2组均无严重不良反应发生。结论硬膜外分娩镇痛能有效减轻应激反应,且对神经行为与胎盘灌注无影响。Objective To investigate the changes of maternal and neonatal serum cortisol(COR)and plasma endothelin-1(ET-1)after epidural labor analgesia,and to analyze its effect on neurobehavior and placental perfusion.Methods A total of 96 pregnant women who gave birth in Maternal and Child Health Hospital of Anhui Province from January 2019 to December 2019 were prospectively enrolled,and divided into two groups by random number table methods.The observation group(n=48)were received epidural labor analgesia,and the control group(n=48)were received normal birth.The levels of serum COR and ET-1 during incubation period(T1),active period(T2)and delivery period(T3)and neonatal were compared between two groups;Bromage score was used to evaluate the neurobehavioral changes of parturients in different periods;visual analog scale(VAS)score,adverse reactions and complications were recorded and compared between groups.Results There was no significant difference in serum COR levels between the two groups at T1 time point(P>0.05);the levels of serum COR in observation group at T2 and T3 time points were(613.67±122.23)and(586.46±91.52)ng/mL,which were significant lower than those in the control group[(763.58±103.19),(819.97±132.86)ng/mL],the differences were statistically significant(P<0.05).There was no statistically significant difference in the levels of serum ET-1 between the two groups of parturients in each period(P>0.05).The level of COR in the cord blood of the infants in the observation group was(96.62±2.47)ng/mL,which was significantly lower than the control group[(103.96±3.72)ng/mL],the difference was statistically significant(P<0.05).There was no statistically significant difference in the level of ET-1(P>0.05).There was no significant difference in neurobehavior between the two groups(P>0.05).During T1,there was no statistically significant difference in the VAS scores between the two groups(P>0.05).At T2 and T3,the VAS scores in the observation group were(2.45±1.85)and(3.17±0.87)points,which were significantly lo

关 键 词：硬膜外分娩镇痛 应激反应 皮质醇 内皮素-1 神经行为 胎盘灌注 

分 类 号：R714.3[医药卫生—妇产科学]