经皮神经电刺激联合硬膜外阻滞对分娩镇痛产妇疼痛递质、炎症因子及应激反应的影响  

Effects of transcutaneous electrical nerve stimulation combined with epidural block on pain transmitters,inflammatory factors and stress response of parturients with labor analgesia

作　　者：彭玲莉[1] 罗辉[1] 蔡明阳[1] 王昀 赵颖 漆冬梅[1] 罗超容 PENG Ling-li;LUO Hui;CAI Ming-yang(Department of Anesthesiology,Guangdong Women and Children's Hospital,Guangzhou Guangdong 510010,China)

机构地区：[1]广东省妇幼保健院麻醉科,广东广州510010

出　　处：《临床和实验医学杂志》2021年第16期1760-1763,共4页Journal of Clinical and Experimental Medicine

基　　金：广东省省级科技计划项目(编号:2016A020215127)。

摘　　要：目的探究经皮神经电刺激联合硬膜外阻滞对分娩镇痛产妇疼痛递质、炎症因子及应激反应的影响。方法前瞻性选取2019年3月至2020年5月广东省妇幼保健院接收的145例产妇为研究对象,采用随机数字表法分为硬膜外阻滞组72例与经皮神经电刺激联合硬膜外阻滞组(联合组) 73例。对比2组疼痛递质[强啡肽(DYN)、5-羟色胺(5-HT)]、炎症因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)及超敏C-反应蛋白(hs-CRP)]、应激反应[皮质醇(Cor)、去甲肾上腺素(NE)与肾上腺素(E)]、产程时间及分娩结局。结果宫口全开时,联合组DYN、5-HT水平为(0.895±0.032)μg/mL、(2 537.69±784.35)μg/L,均高于硬膜外阻滞组[(0.676±0.027)μg/mL、(2 183.78±624.51)μg/L],IL-1β、IL-6及hs-CRP为(153.06±18.47) pg/mL、(64.83±11.16) pg/mL、(13.84±2.51) mg/mL,水平低于硬膜外阻滞组[(194.73±16.26) pg/mL、(77.42±13.30) pg/mL、(19.43±4.27) mg/mL],差异均有统计学意义(P<0.05)。分娩后30 min,联合组Cor、NE与E为(678.53±55.64) nmol/L、(420.87±17.42) ng/L、(52.76±5.88)ng/L,均低于硬膜外阻滞组[(734.25±63.2) nmol/L、(457.34±20.65) ng/L、(61.84±7.42) ng/L],差异均有统计学意义(P<0.05)。联合组第一产程时间为(441.73±139.42) min,短于对照组[(504.87±165.54) min],中转剖宫产率为10.96%,低于对照组(23.61%),差异均有统计学意义(P<0.05)。结论经皮神经电刺激联合硬膜外阻滞可通调动内源性镇痛系统缓解分娩镇痛,减轻机体炎性反应与应激反应,从而缩短产程。Objective To explore the effects of transcutaneous electrical nerve stimulation combined with epidural block on pain transmitter,inflammatory factors and stress response of parturient with labor analgesia. Methods A total of 145 parturients in Guangdong Women and Children’s Hospital from March 2019 to May 2020 were selected as the subjects and divided into epidural block group and transcutaneous electrical nerve stimulation combined with epidural block group(combined group) according to the random number table method. Pain transmitters[dynorphin(DYN),5-hydroxytryptamine(5-HT) ],inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP) ],stress response,labor process time and delivery outcome of the two groups were compared. Results When the uterine orifice was fully opened,the levels of DYN and 5-HT in the combined group were(0. 895 ± 0. 032) μg/mL and(2 537. 69 ± 784. 35)μg/L,which were higher than those in the epidural block group [(0. 676 ± 0. 027) μg/mL,(2 183. 78 ± 624. 51) μg/L],the level of IL-1β,IL-6 and hs-CRP were(153. 06 ± 18. 47) pg/mL,(64. 83 ± 11. 16) pg/mL,(13. 84 ± 2. 51) mg/mL,which were lower than those in the epidural anesthesia group [(194. 73 ± 16. 26) pg/mL,(77. 42 ± 13. 30) pg/mL,(19. 43 ± 4. 27) mg/mL],the differences were statistically significant(P<0.05). Thirty minutes after delivery,Cor,NE,and E in the combined group were(678. 53 ± 55. 64) nmol/L,(420. 87 ± 17. 42)ng/L,and(52. 76 ± 5. 88) ng/L in the combined group,which were lower than those in the epidural anesthesia group[(734. 25 ± 63. 2) nmol/L,(457. 34 ± 20. 65) ng/L,(61. 84 ± 7. 42) ng/L],the differences were statistically significant(P<0.05). The first stage of labor in the combined group was(441. 73 ± 139. 42) min,which was shorter than that in the control group[(504. 87 ± 165. 54) min],and the conversion rate of cesarean section 10. 96%,which was lower than that in the control group(23. 61%),the difference was statistically significant(P<0.05).Conclus

关 键 词：经皮神经电刺激 硬膜外阻滞 分娩镇痛 疼痛递质 炎症因子 应激反应 

分 类 号：R714.3[医药卫生—妇产科学]