摘要
目的评价硬膜外分娩镇痛对脐动脉血心钠素（ANP）和内皮素-1（ET-1）的影响。方法选择初产妇60例,年龄22~35岁,身高155~170cm,体重60~75kg,孕周〉37周,单胎头位,宫缩正常,ASAⅠ或Ⅱ级,依据产妇自愿原则顺序入组,并据此分为E组和C组,每组30例。E组宫口开至2~3cm时,在L2~3椎间隙行硬膜外穿刺,置入硬膜外导管,1%利多卡因3~5ml作为试验剂量,观察5min后采用患者自控硬膜外镇痛,0.1%罗哌卡因与舒芬太尼0.5μg/ml混合液100ml加入电子镇痛泵,负荷剂量为10ml,背景维持量为6ml/h,单次剂量为5ml,锁定时间15min。C组产妇自愿放弃镇痛措施。记录第一产程时间、第二产程时间、VAS评分、不良反应情况、脐动脉血气分析和新生儿Apgar评分,酶联免疫吸附法测定脐动脉血ANP和ET-1浓度。结果 E组在镇痛后分娩过程中VAS评分明显低于C组（P〈0.05）,且镇痛后各时点VAS评分均低于3分。两组第一产程、第二产程、脐动脉血气分析和新生儿Apgar评分差异无统计学意义。E组脐动脉血ANP和ET-1浓度明显高于C组（P〈0.05）;两组脐动脉血ANP/ET-1浓度比值差异无统计学意义。两组未发生运动阻滞、低血压和恶心呕吐等不良反应。E组有1例出现瘙痒,1例出现耳鸣。结论硬膜外分娩镇痛能够改善胎盘循环,增加脐动脉血ANP和ET-1浓度。
Objective To evaluate the effect of epidural anesthesia for labor analgesia on umbilical artery blood ANP and ET-1.Methods Sixty primipara, aged 22-35 years, height 155-170 cm, weight 60-75 kg, gestationS37 weeks, singleton pregnancy with head delivery and normal contraction, ASA Ⅰ or Ⅱ, were voluntarily divided into two groups （n ：30 each） .. epidural analgesia group （group E） and control group （group C）. An epidural analgesia was given when the cervical dilation was 2-3 cm in group E. The epidural puncture was performed at L2-3 interspace, followed by the insertion of the epidural catheter, administration of a test dose of 1% lidocaine 3-5 ml, and a patient con- trolled epidural analgesia 5 rain later. A 100 ml mixture of 0. 1% ropivacaine with 0.5μg/ml sufen- tanil was put into the electronic analgesia pump. The loading dose was 10 ml and the background infusion was 6 ml/h with a lockout interval time of 15 rain and subsequent bolus of 5 ml. The lasting times of the first stage and the second stage, as well as the VAS score, umbilical artery blood-gas analysis and fetal Apgar scores were all recorded. The concentrations of ANP and ET-1 in umbilical artery blood were determined by enzyme-linked immunosorbent assay （ELISA）. Results In group E, the VAS score of each point was below 3 which was lower than that in group C （P〈0. 05）. There was no significant difference in the duration of the stages of labor, oxytocin consumption, delivery outcome, umbilical artery blood-gas analysis and fetal Apgar scores. The concentration of umbilical artery blood ANP and ET-1 in group E were higher than that in group C （P〈0.05）. No adverse effects such as motor block, hypotension, nausea and vomiting occurred and one case of pruritus and tinnitus occurred in group E.Conclusion Epidural anesthesia for labor analgesia can increase concen- tration of ANP and ET-1 in umbilical artery blood and improves the placental circulation.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2016年第1期46-49,共4页
Journal of Clinical Anesthesiology
基金
常州市卫生局指导项目(WZ201220)
关键词
硬膜外阻滞
分娩镇痛
心钠素
内皮素-1
Epidural anesthesia
Labor analgesial Atrial natriuretic peptide Endothelin-1
