标题：子痫前期患者硬膜外分娩镇痛时机的选择及其对血流动力学、应激反应的影响

      作者：崔卓 1，2，景桂霞 1    1.西安交通大学第一附属医院麻醉科，陕西 西安 710061；2.陕西中医药大学第二附属医院麻醉科，陕西 咸阳 712000

      卷次： 2021年32卷20期

      【摘要】 目的 研究子痫前期患者硬膜外分娩镇痛时机的选择及其对血流动力学、应激反应的影响。方法 选取西安交通大学第一附属医院 2019年 7月至 2020年 7月期间接诊的 80例子痫前期产妇作为研究对象，按照随机数表法分为研究组和对照组各40例。研究组产妇在潜伏期进行分娩镇痛干预，对照组产妇在活跃期进行分娩镇痛干预。比较两组产妇第一产程、第二产程、第三产程时间，疼痛评分情况，皮质醇、促肾上腺皮质激素水平，收缩压(SBP)、舒张压(DBP)、心率(HR)等血流动力学情况，中转剖宫产率、产后出血量、阿氏(Apgar)评分等母婴结局。结果 研究组产妇第一产程时间为(507.5±85.9) min，明显短于对照组的(563.7±98.5) min，差异有统计学意义(P<0.05)，但两组产妇的第二产程、第三产程比较差异均无统计学意义(P>0.05)；研究组产妇在镇痛开始时和宫口扩张2 cm、3 cm时疼痛评分明显低于对照组，差异均有统计学意义P<0.05)，但在宫口扩张4 cm、宫口全开、胎儿分娩时，两组产妇的疼痛评分比较差异均无统计学意义(P>0.05)；分娩镇痛干预前，两组产妇的皮质醇、促肾上腺皮质激素水平比较差异均无统计学意义(P>0.05)；干预后，两组产妇的皮质醇、促肾上腺皮质激素水平明显上升，但研究组产妇的皮质醇、促肾上腺皮质激素水平分别为(435.7±58.3) nmol/L、(72.5±12.3) pg/mL，明显低于对照组的(573.4±64.6) nmol/L、(83.7±13.6) pg/mL，差异均有统计学意义(P<0.05)；产前，两组产妇的SBP、DBP、HR比较差异均无统计学意义(P>0.05)，产时，两组产妇的SBP、DBP、HR明显上升，但研究组产妇的SBP、DBP、HR分别为(153.7±25.8) mmHg、(92.1±15.6) mmHg、(94.2±14.7)次/min，明显低于对照组的(166.4±26.3) mmHg、(102.2±16.8) mmHg、(104.6±15.1)次/min，差异均有统计学意义(P<0.05)；研究组产妇中转剖宫产率为5.0%，明显低于对照组的27.5%，产后出血量为(225.7±26.4) mL，明显少于对照组的(241.4±27.1) mL，Apgar评分为(10.4±1.5)分，明显高于对照组的(9.1±1.2)分，差异均有统计学意义(P<0.05)。结论 子痫前期患者在潜伏期进行硬膜外分娩镇痛有助于缩短第一产程时间，减轻分娩疼痛感，有利于减轻应激反应，对患者血流动力学变化的控制有积极作用，具有临床推广价值。
      【关键词】 子痫前期；分娩；硬膜；镇痛时机；血流动力学；应激反应；镇痛干预；产程
      【中图分类号】 R714.24+5 【文献标识码】 A 【文章编号】 1003—6350（2021）20—2648—04

Timing of epidural labor analgesia and its effect on hemodynamics and stress response in patients withpreeclampsia.
CUI Zhuo 1, 2, JING Gui-xia 1. 1. Department of Anesthesiology, the First Affiliated Hospital of Xi'an JiaotongUniversity, Xi'an 710061, Shaanxi, CHINA; 2. Department of Anesthesiology, the Second Affiliated Hospital of ShaanxiUniversity of Traditional Chinese Medicine, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To study the timing of epidural labor analgesia and its effect on hemodynamics andstress response in patients with preeclampsia. Methods A total of 80 cases of preeclampsia in the First Affiliated Hospi-tal of Xi'an Jiaotong University from July 2019 to July 2020 were selected as the research objects, and they were dividedinto a study group and a control group according to the random number table method, with 40 cases in each group. Thestudy group received labor analgesia intervention during the latent period, and the control group was given labor analge-sia intervention during the active period. The duration of the first, second, and third stage of labor were compared be-tween the two groups, as well as the pain score, the levels of cortisol and adrenocorticotropic hormone (ACTH), some he-modynamics such as systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR), some maternaland infant outcomes such as the rate of conversion to cesarean section, the amount of postpartum hemorrhage, and Apgarscore. Results The duration of the first stage of labor was (507.5±85.9) min in the study group, which was significantlyshorter than (563.7±98.5) min in the control group (P<0.05); but there was no statistically significant difference in thesecond and third stage of labor between the two groups (P>0.05). The pain scores of the parturient at the beginning of an-algesia, at 2 cm and 3 cm cervical dilation were significantly lower in the study group than in the control group (P<0.05); however, there was no statistically significant difference in pain scores between the two groups at 4 cm cervical di-lation, full dilation, and fetal delivery (P>0.05). Before the intervention of labor analgesia, there was no significant differ-