【摘要】 目的观察分娩潜伏期硬膜外镇痛对宫缩的影响。方法单胎头位正常初产妇120例分为三组:E组和D组在分娩潜伏期行硬膜外自控镇痛(PCEA),D组在镇痛开始时静脉注射地塞米松10mg,C组未镇痛。观察镇痛开始时(T0)、镇痛1h(T1)、2h(T2)时疼痛评分(VAS)和宫缩强弱的变化,T0和T2时产妇血浆皮质醇(Cor)、催产素(OT)、促肾上腺皮质激素释放激素(CRH)、前列腺素E2和前列腺素F2α的代谢物(PGEM和PGFM)、雌二醇(E2)、孕酮(P)等激素水平的变化,记录缩宫素使用情况。结果在T1、T2时,C组VAS评分明显高于E、D组(P<0.01)。C组宫缩强度显著优于E、D组(P<0.01或P<0.05),D组显著优于E组(P<0.05)。C组缩宫素使用率显著小于E、D组(P<0.01或P<0.05),D组显著小于E组(P<0.05)。与C组比较,E组或D组第一产程延长约80min(P<0.01),第二产程延长约10min(P<0.01)。在T2时,C组血浆Cor、CRH、OT、PGEM、PGFM水平明显高于E、D组(P<0.05),D组血浆CRH、PGEM和PGFM水平明显高于E组(P<0.05)。结论分娩潜伏期硬膜外镇痛可致宫缩抑制;神经阻滞后应激反应减轻致一些促宫缩激素分泌减少是其可能机制之一。更多还原

【Abstract】 Objective To investigate the effect of epidural analgesia during delivery latency on uterine contraction.Methods A total of 120 healthy full-term pregnancy primiparas with single and cephalic presentation fetal was equally divided into three groups.During the delivery latency,group E was given patient-controlled epidural analgesia(PCEA),group D was given PCEA plus dexamethasone 10 mg,and group C was taken as blank control.Before PCEA(T0)、at 1 h(T1) and 2 h(T2) during PCEA,the changes of VAS pain score,uterine contraction parameters were observed and plasma levels of cortisol(Cor),oxytocin(OT),corticotropin releasing hormone(CRH),the metabolites(PGEM and PGFM) of PGE2 and PGF2α,estradiol(E2),pregnendione(P) were examined.Results Within 2 hours of analgesia,VAS scores in group C were significantly higher than those in groups of E and D(P<0.01).The uterine contraction in group C was significantly stronger than that in groups of E(P<0.01) and D(P<0.05) with less need for oxytocin use(P<0.01 or P<0.05),which was stronger in group D than that in group E(P<0.05).Compared to group C,the first labor course was 80 min and second labor course was 10 min longer in groups of E and D(P<0.01).At T2,plasma levels of Cor,CRH,OT,PGEM and PGFM were higher in group C than those in groups of D and E(P<0.05).Plasma levels of CRH,PGEM and PGFM were higher in group D than those in group E(P<0.05).Conclusion Epidural analgesia during delivery latency may inhibit uterine contraction.One of the mechanisms for this is a decrease of hormone secretion promoting uterine contraction,which results from reduced stress response after nerve block.更多还原