腰硬联合麻醉复合硬膜外镇痛对妊娠高血压产妇行无痛分娩的产程时间及术后血清PRL、t-PA水平的影响  

The effect of combined spinal-epidural anesthesia with epidural analgesia on the labor time and serum PRL and t-PA levels of pregnant women with hypertension

作　　者：杨恩亮 田秀娟[2] 李聪颖 祁广晶 武莉芳[3] 陈云飞[1] 苏心镜[1] YANG Enliang;TIAN Xiujuan;LI Congying(不详;Department of Anesthesiology,the Second Affiliated Hospital of Hebei North University,Hebei,Zhangjiakou 075100,China)

机构地区：[1]河北北方学院附属第二医院麻醉科,河北省张家口市075100 [2]河北北方学院附属第二医院妇产科,河北省张家口市075100 [3]河北北方学院附属第二医院检验科,河北省张家口市075100

出　　处：《河北医药》2023年第7期1011-1014,1018,共5页Hebei Medical Journal

基　　金：河北省卫生健康委科研基金项目(编号:20212200)。

摘　　要：目的探讨腰硬联合麻醉复合硬膜外镇痛对妊娠高血压产妇行无痛分娩产程时间及术后血清泌乳素(serum prolactin,PRL)、组织型纤溶酶原激活物(tissue-type plasminogen activator,t-PA)水平的影响。方法回顾性分析2019年5月至2020年4月妊娠高血压产妇的临床资料,选取其中122例一般情况相近的病例,按照镇痛方法不同分为对照组和观察组,每组61例。2组一般资料比较差异无统计学意义(P>0.05)。对照组产妇采用导乐分娩镇痛措施,观察组产妇采用腰硬联合麻醉复合硬膜外镇痛措施。比较2组产妇产程时间、血清PRL水平、血清t-PA水平、疼痛程度、收缩压和舒张压、产后出血情况和分娩方式。结果镇痛干预后2组产妇第二产程时间、自然分娩率、剖宫产率、产钳助产率、新生儿Apgar评分比较差异无统计学意义(P>0.05)。观察组第一产程、第三产程时间低于对照组(P<0.05);2组产妇分娩后3、12 h血清PRL水平显著升高,观察组高于对照组(P<0.05);分娩后血清t-PA水平升高(P<0.05),观察组低于对照组(P<0.05);镇痛后产妇第一、二、三产程疼痛程度缓解,观察组疼痛程度水平低于对照组(P<0.05);镇痛后5、10 min及活跃期、第二产程2组产妇收缩压与舒张压均下降,观察组低于对照组,差异有统计学意义(P<0.05)。结论对妊娠高血压产妇分娩采用腰硬联合麻醉复合硬膜外镇痛可有效减少产程时间、降低血压水平,升高产后血清PRL水平、降低t-PA水平,镇痛效果良好,值得临床参考应用。Objective To investigate the effect of combined spinal-epidural anesthesia with epidural analgesia on the labor time of painless delivery and postoperative levels of serum prolactin(PRL)and tissue-type plasminogen activator(t-PA)in pregnant women with hypertension.Methods Clinical data of pregnant women with hypertension who were admitted from May 2019 to April 2020 were retrospectively analyzed.A total of 122 cases with similar general conditions were selected and assigned to control group and observation group according to different analgesic methods,with 61 cases in each group.Doula labor analgesia was performed in pregnant women of control group,while combined spinal-epidural anesthesia with epidural analgesia was applied to those of observation group.There were no significant differences in the general data between the two groups(P>0.05).The labor time,serum PRL and t-PA levels,pain level,systolic and diastolic blood pressure,postpartum hemorrhage and mode of delivery were compared between the two groups.Results After analgesia,there were no significant differences in the duration of second stage of labor,natural delivery rate,cesarean section rate,forceps midwifery rate,and neonatal Apgar score between the two groups(P>0.05).The duration of the first and third stage of labor was significantly shorter in the observation group than that in control group(P<0.05).Serum PRL levels in both groups increased significantly at 3 and 12 hours after delivery,which were significantly higher in the observation group than those in control group(P<0.05).Serum t-PA levels significantly increased after delivery(P<0.05),which were significantly lower in the observation group than those in control group(P<0.05).After analgesia,the pain in the first,second and third stages of labor was relieved,which was significantly milder in the observation group than that in control group(P<0.05).The systolic blood pressure and diastolic blood pressure of puerperae in the two groups decreased at 5 and 10 minutes after analgesia,and in the a

关 键 词：腰硬联合麻醉 硬膜外镇痛 妊娠高血压 产妇 无痛分娩 

分 类 号：R614[医药卫生—麻醉学]