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41卷第8期
观察硬膜外分娩镇痛下产妇体温、炎性细胞因子的变化
Changes of Maternal Body Temperature and Inflammatory Cells factors under Epidural Labor Analgesia
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DOI:
作者:
何虹
HE Hong
作者单位:
长宁区妇幼保健院
Shanghai Changning Maternity & Infant Health Hospital
关键词:
自然分娩;硬膜外;镇痛;产时发热;炎性细胞因子
Natural labor, Epidural,Analgesia , Intrapartum fever, Inflammatory Cells factors
摘要:
目的:观察硬膜外分娩镇痛对产妇体温、炎性细胞因子变化的影响。方法: 采用随机数字法进行随机分两组:硬膜外阻滞分娩镇痛组(E组),和随机选择同期在本院阴道分娩、非硬膜外阻滞分娩镇痛的产妇作为对照组(C组)。分别在硬膜外阻滞分娩镇痛前1天(时间1);硬膜外阻滞分娩镇痛前(时间2);分娩后2小时,离开产房前(时间3)分娩后24小时(时间4)四个时间点对两组产妇分别进行疼痛评分,测量体温。在硬膜外阻滞分娩镇痛前和分娩后24小时采静脉血测定炎性细胞因子。结果: 观察硬膜外分娩镇痛对产妇体温的影响,观察结果显示: E组分娩后2小时产妇体温比分娩镇痛前明显升高(p<0.01),而C组分娩后2小时产妇体温比分娩前宫口3cm无明显升高(p>0.05)。组间比较:E组组硬膜外分娩镇痛后2小时和24小时产妇体温均比C组产妇体温明显升高(p<0.01)。观察硬膜外分娩镇痛下产妇炎性细胞因子的变化:硬膜外分娩镇痛对产妇炎性细胞因子的影响:观察结果显示:分娩前 E组体温升高产妇血IL-6水平明显高于体温正常产妇(p<0.05),而C组体温升高产妇血IL-6水平与体温正常产妇则没有差异(p>0.05);分娩前E组和C组体温升高产妇血PCT和 TNF-a水平与体温正常产妇没有差异(p<0.05);分娩后 E组和C组体温升高产妇血IL-6水平明显高于体温正常产妇(p<0.01);分娩后E组和C组体温升高产妇血PCT水平与体温正常产妇没有差异(p>0.05);分娩后 E组体温升高产妇血TNF-a水平明显高于体温正常产妇(p<0.01),而C组体温升高产妇血TNF-a水平与体温正常产妇则没有差异(p>0.05)结论:硬膜外分娩镇痛下产时发热是由多种因素造成的,其中非感染炎性因子IL-6和TNF-a水平明显升高,而感染炎性因子PCT水平没有明显变化,并且预防性使用抗生素并不能控制硬膜外分娩镇痛下产时发热,非感染炎性因素在硬膜外分娩镇痛产时发热中起着重要作用。
Objective: To observe the changes of body temperature and inflammatory cells factors in epidural labor analgesia. Methods: Delivery women were randomly divided into two groups: epidural block labor analgesia group (E group), and randomly selected from the same period in the hospital vaginal delivery, non epidural block labor analgesia of maternal as control group (C group). Each group in epidural analgesia before 1 days (time 1); before epidural labor analgesia (time 2); 2 hours after childbirth before leaving the delivery room (time 3) 24 hours after delivery (time 4) four time points of two groups respectively for pain score, body temperature measurement. The blood levels of inflammatory cytokines were measured by intravenous blood sampling a before epidural analgesia and at 24 hours after epidural analgesia. Results: To observe the effect of epidural analgesia on maternal body temperature, the results showed that: Temperature of maternal body of group E in 2 hours after delivery was significantly higher (p<0.01) than that in 2 hours before delivery, Temperature of maternal body of group C in 2 hours after delivery had no significant increase (P > 0.05). Group comparison: E group epidural labor analgesia after 2 hours and 24 hours of maternal body temperature than the C group maternal body temperature was significantly increased (p<0.01). To observe the changes of inflammatory cytokines in parturients undergoing epidural labor analgesia: The results showed that before delivery, the temperature of the E group increased, the maternal blood IL-6 level was significantly higher than that of the normal temperature maternal (p<0.05), while the body temperature in the C group increased, and the maternal blood IL-6 level was not different from that of the normal temperature (P > 0.05); There is no difference before the birth of E group and C group increased body temperature in maternal blood PCT and TNF-a levels and body temperature of normal pregnant women (p<0.05); E group and C group increased body temperature after childbirth maternal blood IL-6 level was significantly higher than that of normal maternal body temperature (p<0.01); there is no difference between the E group and C group after delivery temperature increased the level of PCT in maternal blood and body temperature normal pregnant women (P > 0.05); E group increased body temperature after childbirth maternal blood TNF-a level was significantly higher than normal body temperature (p<0.01), maternal C group elevated body temperature TNF-a level and temperature of maternal blood of normal pregnant women and there was no significant difference (P > 0.05) Conclusion: Intrapartum fever under epidural analgesia is caused by a variety of factors,which noninfectious inflammatory factors IL-6 and TNF-a levels were significantly increased, while the infection of inflammatory factor PCT levels did not change significantly, and the preventive use of antibiotics can not control the intrapartum fever under epidural analgesia. Noninfectious inflammatory factors in epidural analgesia during labor heating plays an important role.
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