摘要
目的 探讨硬脊膜穿破硬膜外阻滞(DPE)用于分娩镇痛的效果及对疼痛递质和应激反应指标的影响。方法 选择2021年2月至2022年6月在丽水市人民医院行分娩镇痛的产妇120例,依据随机数字表法分为观察组和对照组,每组60例。对照组采用硬膜外分娩镇痛,观察组采用DPE镇痛。比较两组产妇不同时点(镇痛前、镇痛30 min、宫口开全和分娩)宫缩视觉模拟评分法(VAS),镇痛起效时间和持续时间,产妇分娩情况;分娩前和分娩24 h产妇疼痛递质[前列腺素E2(PGE2)、P物质(SP)]和应激反应指标[甲肾上腺素(NE)、皮质醇(Cor)、肾上腺皮质激素(ACTH)]的差异。结果 两组产妇镇痛前宫缩VAS评分差异无统计学意义(P>0.05);观察组镇痛30 min、宫口开全和分娩宫缩VAS评分均低于对照组(均P<0.05)。观察组镇痛起效时间快于对照组(P<0.05);而两组镇痛持续时间、自然分娩率及第一、二、三产程时间比较差异均无统计学意义(均P>0.05)。两组产妇分娩后24 h血清PGE_2、SP、NE、Cor和ACTH水平均高于分娩前(均P<0.05),观察组分娩后24 h血清PGE_2、SP、NE、Cor和ACTH水平均低于对照组(均P<0.05)。结论 DPE用于产妇分娩镇痛效果良好,可抑制疼痛递质释放,减轻其应激反应。
Objective To investigate the efficacy of dural puncture epidural(DPE)block on labor analgesia and its effect on pain transmitter level and stress state of parturients.Methods One hundred and twenty parturients receiving delivery analgesia in Lishui People's Hospital from February 2021 to June 2022 were randomly divided into two groups with 60 cases in each group.Parturients in the control group were given epidural labor analgesia,and those in the study group were given DPE analgesia.The contraction visual analogue scales(VAS)at different time points(before pain relief,30 min of pain relief,complete uterine opening,and delivery),the onset time and duration of analgesia,and the parturient delivery were documented and compared between two groups.The serum levels of prostaglandin E2(PGE2)and substance P(SP),norepinephrine(NE),cortisol(Cor),and adrenocortical hormone(ACTH)were measured before delivery and 24 h after delivery.Results There was no significant difference in contraction VAS scores before analgesia between two groups(P>0.05);while VAS scores contraction at 30 min after analgesia,uterine opening and delivery in study group were lower than those in the control group(all P<0.05).The onset time of analgesia in study group was significantly faster than that in the control group(P<0.05);while there was no significant difference in the duration of analgesia between two groups(P>0.05).The natural delivery rate,the first,second and third stage of labor were not significant different between two groups(all P>0.05).The serum PGE2,SP,NE,Cor and ACTH levels 24 h after delivery were significantly higher than those before delivery in both groups(all P<0.05);however,the levels in study were lower than those in the control group(all P<0.05).Conclusion DPE is a good analgesic efficacy for labor analgesia,it can inhibit the release of pain transmitters with little effect on stress state in parturients.
作者
游敏吉
翁晓华
代虹
吴继敏
刘志平
YOU Minji;WENG Xiaohua;DAI Hong;WU Jimin;LIU Zhiping(Department of Anesthesiology,Lishui People's Hospital,Lishui 323000,China)
出处
《浙江医学》
CAS
2023年第23期2526-2530,共5页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2019ZH070、2022ZH023)
浙江省医学会科研项目(2017ZYC-A131)。
作者简介
通信作者:游敏吉,E-mail:youminji@163.com。
