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不同浓度罗哌卡因对硬膜外分娩镇痛产妇产时发热、白细胞介素-6和肿瘤坏死因子-α的影响

Ropivacaine at different concentrations on intrapartum fever, IL-6 and TNF-α in parturient with epidural labor analgesia.

作者信息

Zhou Xianjin, Li Jiang, Deng Shengqiong, Xu Zhendong, Liu Zhiqiang

机构信息

Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, P.R. China.

Department of Laboratory, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai 200135, P.R. China.

出版信息

Exp Ther Med. 2019 Mar;17(3):1631-1636. doi: 10.3892/etm.2018.7121. Epub 2018 Dec 20.

Abstract

Effects of ropivacaine at different concentrations on intrapartum fever, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in parturient with epidural labor analgesia were compared to provide reference for the rational selection of anesthetics in clinic. Medical records of 198 cases of primi-paras admitted to the Obstetrics and Gynecology Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, from January 2017 to January 2018 were analyzed retrospectively and divided into 2 groups. A total of 105 patients were treated with 0.075% ropivacaine injection 10 ml and 0.5 µg/ml sulfentanyl injection 100 ml in parturition as the experimental group, and 93 patients were treated with 0.1% ropivacaine injection 10 ml and 0.5 µg/ml sulfentanyl injection 100 ml in parturition as the control group. After patient-controlled epidural analgesia, the pain visual analogue score (VAS), labor duration, administration time and febrile rate of parturient after administration were compared between the two groups at different time-points. Venous blood 2 ml was taken at T1 (cervix open to 2 cm), T2 (cervix fully open) and T3 (24 h postpartum), and the concentration of IL-6 TNF-α was detected by enzyme-linked immunosorbent assay. The time of the second stage of labor and analgesia were shorter in the experimental group than that in the control group after administration (P<0.05). The febrile rate of parturient in the experimental group was lower than that in the control group (P<0.05). The concentration of IL-6 and TNF-α in the experimental group was lower than that in the control group at T2 (P<0.05; P<0.01). The effect of patient-controlled epidural administration with 0.075% ropivacaine injection combined with 0.5 mg/ml sulfentanyl injection on labor analgesia is shorter than that with 0.1% ropivacaine combined with sulfentanyl. It could also shorten the duration of the second stage of labor, reduce the intrapartum febrile rate, and alleviate inflammation.

摘要

比较不同浓度罗哌卡因对硬膜外分娩镇痛产妇产时发热、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的影响,为临床合理选择麻醉药物提供参考。回顾性分析2017年1月至2018年1月同济大学医学院附属上海第一妇婴保健院妇产科收治的198例初产妇的病历资料,并将其分为2组。105例患者在分娩时采用0.075%罗哌卡因注射液10 ml和0.5 μg/ml舒芬太尼注射液100 ml进行治疗作为试验组,93例患者在分娩时采用0.1%罗哌卡因注射液10 ml和0.5 μg/ml舒芬太尼注射液100 ml进行治疗作为对照组。在患者自控硬膜外镇痛后,比较两组产妇在不同时间点给药后的疼痛视觉模拟评分(VAS)、产程、给药时间及发热率。分别于T1(宫口开大2 cm)、T2(宫口开全)和T3(产后24 h)采集静脉血2 ml,采用酶联免疫吸附法检测IL-6、TNF-α的浓度。给药后试验组第二产程及镇痛时间短于对照组(P<0.05)。试验组产妇发热率低于对照组(P<0.05)。T2时试验组IL-6、TNF-α浓度低于对照组(P<0.05;P<0.01)。0.075%罗哌卡因注射液联合0.5 mg/ml舒芬太尼注射液患者自控硬膜外给药用于分娩镇痛的效果优于0.1%罗哌卡因联合舒芬太尼,还可缩短第二产程时间,降低产时发热率,减轻炎症反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5622/6364190/612abb23f53a/etm-17-03-1631-g00.jpg

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