硬膜外镇痛分娩对脐动脉血ANP、NO、ET-1的影响
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摘要
目的分析硬膜外镇痛分娩对脐动脉血ANP、NO、ET-1的影响。方法选择健康单胎初产妇61例,依据产妇镇痛自愿原则分为镇痛组36例,对照组25例。镇痛组采用患者自控硬膜外镇痛,在宫口开至3cm时,L2～3间隙置入硬膜外导管连接镇痛泵。胎儿娩出后,抽取两组产妇脐动脉血2～4mL,并按规定时间离心脐动脉血,以酶免疫吸附法测定ANP、NO、ET-1水平。结果两组ANP与ET-1之间存在正相关性,在脐动脉血中ANP、NO、ET-1浓度值镇痛组较对照组偏高,但P>0.05,无统计学意义。结论硬膜外麻醉下分娩镇痛是安全可行的,可能通过脐动脉血ATP、NO、ET-1等因子调节胎盘血流量,具体机制及作用还有待大量样本的研究证实。
Objective To analyze the effects of epidural labor analgesia on ANP, NO and ET-1 in umbilical arterial blood.Methods Sixty-one healthy primiparas were selected and divided into analgesia group(36 cases) and control group(25 cases)according to the principle of voluntary analgesia. In the analgesia group, patient-controlled epidural analgesia was used. When the cervix was opened to 3 cm, an epidural puncture was performed in the L2～3 intervertebral space, and an epidural catheter was placed at the head end and then connected to a PCA pump. After the fetus was delivered, 2～4 mL of umbilical arterial blood was taken from each group; the concentration of ANP, NO and ET-1 in umbilical arterial blood was measured by Elisa method.Results The contents of ANP, NO and ET-1 in the umbilical arterial blood of the labor analgesia group were higher than those of the control group, but the difference was not statistically significant(P>0.05). Conclusion Epidural labor analgesia is safe and feasible. It is possible to regulate uterine placental blood flow by increasing umbilical arterial blood ANP, NO, ET-1 and other factors. The specific mechanism remains to be further studied.
Objective To analyze the effects of epidural labor analgesia on ANP, NO and ET-1 in umbilical arterial blood.Methods Sixty-one healthy primiparas were selected and divided into analgesia group(36 cases) and control group(25 cases)according to the principle of voluntary analgesia. In the analgesia group, patient-controlled epidural analgesia was used. When the cervix was opened to 3 cm, an epidural puncture was performed in the L2～3 intervertebral space, and an epidural catheter was placed at the head end and then connected to a PCA pump. After the fetus was delivered, 2～4 mL of umbilical arterial blood was taken from each group; the concentration of ANP, NO and ET-1 in umbilical arterial blood was measured by Elisa method.Results The contents of ANP, NO and ET-1 in the umbilical arterial blood of the labor analgesia group were higher than those of the control group, but the difference was not statistically significant(P>0.05). Conclusion Epidural labor analgesia is safe and feasible. It is possible to regulate uterine placental blood flow by increasing umbilical arterial blood ANP, NO, ET-1 and other factors. The specific mechanism remains to be further studied.
引文
[1]Delgado C,Ciliberto C,Bollag L,et al.Continuous epidural infusion versus programmed intermittent epidural bolus for labor analgesia:optimal configuration of parameters to reduce physician-administered top-ups[J].Curr Med Res Opin,2018,34(4):649-656.
[2]吴利君,周取升,吴焘,等.PCEA-LP与PCEA-LCP两种给药方式对产妇自控硬膜外分娩镇痛及分娩效果的影响[J].中国妇幼保健,2017,32(16):3996-3998.
[3]Song W,Wang H,Wu Q.Atrial natriuretic peptide in cardiovascular biology and disease(NPPA)[J].Gene,2015,569(1):1-6.
[4]Kulandavelu S,Whiteley KJ,Bainbridge SA,et al.Endothelial NO synthase augments fetoplacental blood flow,placental vascularization,and fetal growth in mice[J].Hypertension,2013,61(1):259-266.
[5]Aggarwal PK,Chandel N,Jain V,et al.The relationship between circulating endothelin-1,soluble fms-like tyrosine kinase-1 and soluble endoglin in preeclampsia[J].J Hum Hypertens,2012,26(4):236-241.
[6]沈晓凤,姚尚龙.分娩镇痛专家共识(2016版)[J].临床麻醉学杂志,2016,32(8):816-818.
[7]Sng BL,Kwok SC,Sia AT.Modern neuraxial labour analgesia[J].Curr Opin Anaesthesiol,2015,28(3):285-289.
[8]Zupan Simunek V.Definition of intrapartum asphyxia and effects on outcome[J].J Gynecol Obstet Biol Reprod(Paris),2008,37 Suppl 1(37 Suppl 1):7-15.
[9]Walther T,Stepan H,Faber R.Dual natriuretic peptide response to volume load in the fetal circulation[J].Cardiovasc Res,2001,49(4):817-819.
[10]Zhang L,Paradis A.Role of Endothelin in Uteroplacental Circulation and Fetal Vascular Function[J].Current Vascular Pharmacology,2013,11(5):594-605.
[2]吴利君,周取升,吴焘,等.PCEA-LP与PCEA-LCP两种给药方式对产妇自控硬膜外分娩镇痛及分娩效果的影响[J].中国妇幼保健,2017,32(16):3996-3998.
[3]Song W,Wang H,Wu Q.Atrial natriuretic peptide in cardiovascular biology and disease(NPPA)[J].Gene,2015,569(1):1-6.
[4]Kulandavelu S,Whiteley KJ,Bainbridge SA,et al.Endothelial NO synthase augments fetoplacental blood flow,placental vascularization,and fetal growth in mice[J].Hypertension,2013,61(1):259-266.
[5]Aggarwal PK,Chandel N,Jain V,et al.The relationship between circulating endothelin-1,soluble fms-like tyrosine kinase-1 and soluble endoglin in preeclampsia[J].J Hum Hypertens,2012,26(4):236-241.
[6]沈晓凤,姚尚龙.分娩镇痛专家共识(2016版)[J].临床麻醉学杂志,2016,32(8):816-818.
[7]Sng BL,Kwok SC,Sia AT.Modern neuraxial labour analgesia[J].Curr Opin Anaesthesiol,2015,28(3):285-289.
[8]Zupan Simunek V.Definition of intrapartum asphyxia and effects on outcome[J].J Gynecol Obstet Biol Reprod(Paris),2008,37 Suppl 1(37 Suppl 1):7-15.
[9]Walther T,Stepan H,Faber R.Dual natriuretic peptide response to volume load in the fetal circulation[J].Cardiovasc Res,2001,49(4):817-819.
[10]Zhang L,Paradis A.Role of Endothelin in Uteroplacental Circulation and Fetal Vascular Function[J].Current Vascular Pharmacology,2013,11(5):594-605.