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分娩时的硬膜外镇痛与新生儿应激标志物。

Epidural analgesia during labour and stress markers in the newborn.

机构信息

Department of Surgery and Medical and Surgical Specialties - Section of Anaesthesiology and Intensive Care, University of Catania (Italy), Catania, Italy.

School of Specialization in Anaesthesia, Resuscitation, Intensive Care and Pain Medicine, University of Catania, Catania, Italy.

出版信息

J Obstet Gynaecol. 2021 Jul;41(5):690-692. doi: 10.1080/01443615.2020.1755621. Epub 2020 Jun 4.

Abstract

Labour and modes of delivery can influence the plasma levels of stress hormones and cytokines involved in pathophysiologic cascade, potentially damaging brain development of the newborn. This prospective observational, single-centre, case-control, non-profit study aimed to detect potential differences in foetal well-being such as stress neuroendocrine responses. Quantitative determinations of the stress markers interleukin (IL)-1β, IL-8, and β-endorphin were compared between the control group and the epidural analgesia group. We found higher IL1-β levels but lower IL-8 and β-endorphin levels in the epidural analgesia group than in the control group. No significant inter-group differences were observed for any parameters. Our findings demonstrate that epidural analgesia for pain relief during labour does not result in significant differences in blood stress response markers.IMPACT STATEMENT We already know that plasma levels of stress hormones and cytokines are influenced by labour and delivery modes. This has a deep impact on the newborn in terms of brain damage, immune system deficits, and altered hypothalamic-pituitary axis responses. We also know that epidural analgesia is a widespread practice that offers pain relief to the woman in labour, but there are few studies on the potentially negative effects of epidural labour analgesia on the unborn child. This study found no significative differences in blood stress response markers between the epidural analgesia group and the control group. Under this study circumstances we found out that epidural analgesia does not significantly influence the newborn's well-being during labour and delivery. These findings must be confirmed by further studies to verify whether epidural analgesia is safe for the newborn's development.

摘要

分娩方式会影响参与病理级联反应的应激激素和细胞因子的血浆水平,这可能会损害新生儿的大脑发育。这项前瞻性观察性、单中心、病例对照、非营利性研究旨在检测胎儿健康状况(如应激神经内分泌反应)的潜在差异。在对照组和硬膜外镇痛组之间比较了应激标志物白细胞介素(IL)-1β、IL-8 和 β-内啡肽的定量测定值。我们发现硬膜外镇痛组的 IL1-β水平较高,而 IL-8 和 β-内啡肽水平较低。两组之间任何参数均无显著差异。我们的研究结果表明,分娩时缓解疼痛的硬膜外镇痛不会导致血液应激反应标志物的显著差异。
研究意义
我们已经知道,应激激素和细胞因子的血浆水平会受到分娩方式的影响。这会对新生儿的大脑损伤、免疫系统缺陷和下丘脑-垂体轴反应产生深远影响。我们还知道,硬膜外镇痛是一种广泛应用的缓解分娩疼痛的方法,但关于硬膜外分娩镇痛对未出生婴儿的潜在负面影响的研究较少。本研究未发现硬膜外镇痛组与对照组之间血液应激反应标志物存在显著差异。在本研究的情况下,我们发现硬膜外镇痛不会显著影响分娩期间新生儿的健康状况。这些发现需要进一步的研究来证实硬膜外镇痛是否对新生儿的发育安全。

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