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观察硬脊膜外腔阻滞分娩镇痛产妇体温和炎性细胞因子的变化 被引量:11

Changes of maternal body temperature and inflammatory cytokines under epidural labor analgesia
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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在上海市长宁区妇幼保健院2014年1月—2015年12月阴道分娩的产妇中随机选择病例,根据分娩过程中是否采用镇痛分为硬脊膜外腔阻滞分娩镇痛组(镇痛组,140例)和对照组(50例)。分别在分娩前1d、行硬脊膜外腔阻滞前(对照组为宫口开至3cm时)、分娩后2h和分娩后24h测量两组产妇的体温。在宫口开至3cm和分娩后24h采集静脉血测定IL-6、TNF-α和降钙素原(PCT)等细胞因子。比较分娩前1d、行硬脊膜外腔阻滞镇痛前、分娩后2h和分娩后24h预防性使用抗生素和未使用抗生素的产妇体温的差异。结果镇痛组产妇分娩后2h的体温比行硬脊膜外腔阻滞前显著升高(P<0.01),而对照组产妇这两个时间点体温的差异无统计学意义(P>0.05)。镇痛组产妇分娩后2和24h的体温均显著高于对照组同时间点(P值均<0.05)。在镇痛组中,行硬脊膜外腔阻滞前,体温升高的产妇血IL-6水平显著高于体温正常的产妇(P<0.01),PCT和TNF-α水平的差异均无统计学意义(P值均>0.05);分娩后24h,镇痛组体温升高的产妇血IL-6、TNF-α水平均显著高于体温正常的产妇(P值均<0.01),PCT水平的差异无统计学意义(P>0.05)。在对照组中,宫口开至3cm时体温升高的产妇血IL-6、PCT和TNF-α水平与体温正常的产妇比较,差异均无统计学意义(P值均>0.05);分娩后24h,体温升高的产妇血IL-6水平显著高于体温正常的产妇(P<0.01),TNF-α、PCT水平的差异均无统计学意义(P值均>0.05)。预防性使用抗生素与未使用抗生素的产妇在所有时间点体温的差异均无统计学意义(P值均>0.05)。结论非感染炎性因素在硬脊膜外腔阻滞分娩镇痛导致的产时发热中起着重要作用。 Objective To observe the changes of body temperature and inflammatory cytokines in epidural labor analgesia. Methods The parturients who underwent vaginal delivery in Shanghai Changning Maternity and Infant Health Hospital between January 2014 and December 2015 were enrolled in this study according to random digital method. Epidural block labor analgesia was performed in 140 women (analgesia group), but not in other 50 women (control group). Maternal body temperature was detected on the day before delivery, before epidural labor analgesia, 2 h after childbirth, and 24 h after delivery. Venous blood was collected to measure the levels of inflammatory cytokines (interleukin [IL]-6, tumor necrosis factor [TNF]-α and procalcitonin [PCT]) before epidural analgesia and at 24 h after epidural analgesia. The effect of prophylactic use of antibiotics on maternal body temperature was detected in parturients. Results The body temperature of parturients in analgesia group at 2 h after delivery was significantly higher than that before epidural labor analgesia (P〈0.01), while there was no significant difference in the maternal body temperature between the two time points in control group ( P〉0.05). The maternal body temperature in analgesia group was significantly higher than that in control group at 2 h and 24 h after delivery (both P〈0.05). In analgesia group, IL-6 level in the parturients with elevated temperature was significantly higher than that in those with normal temperature before epidural labor analgesia (P〈0.01), while no significant difference was found in the POT or TNF-α between these women (both P〉0.05);IL-6 and TNF-α levels in the parturients with elevated temperature were significantly higher than those in those women with normal temperature at 24 h after delivery (both P〈0.01 ), while no significant difference was found in the PCT between these women (P〉0.05). In control group, there was no significant difference in the levels of IL-6, POT or TNF-α between the parturients with and without normal temperature before analgesia (all P〉0.05) ;IL-6 level in the parturients with elevated temperature was significantly higher than that in those women with normal temperature (P〈0.01), while no significant difference was found in the POT or TNF-αbetween these women (both P〉0.05). There was no significant difference in the body temperature between the women with and without prophylactic use of antibiotics ( P 〉 0. 05), Conclusion Noninfectious inflammatory factors play an important role in intrapartum fever induced by epidural labor analgesia.
作者 何虹 章莉 龚波 曹爽 孙静璐 沈丽敏 王红 熊源长 HE Hong;ZHANG Li;GONG Bo;CAO Shuang;SUN Jinglu;SHEN Limin;WANG Hong;XIONG Yuanchang(Department of Anesthesiology,Shanghai Changning Maternity & Infant Health Hospital,Shanghai 200051,China)
出处 《上海医学》 CAS 北大核心 2018年第8期472-476,共5页 Shanghai Medical Journal
基金 上海市长宁区卫生和计划生育委员会科研基金(2013Y05001)
关键词 自然分娩 镇痛 硬膜外 炎性细胞因子 Natural childbirth Analgesia epidural Inflammatory cytokines
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