摘要
目的研究地塞米松在硬膜外分娩镇痛相关产时发热中的应用效果。方法选取2020年1月至2021年8月西北妇女儿童医院接诊的200例产妇作为研究对象,按照随机数表法将其分为研究组和对照组各100例。两组产妇均进行硬膜外阻滞分娩镇痛术,研究组产妇给予硬膜外首剂(0.1%的罗哌卡因和0.5μg/mL的舒芬太尼10 mL)及5 mg的地塞米松,对照组产妇给予硬膜外首剂(0.1%的罗哌卡因和0.5μg/mL的舒芬太尼10 m L)及同剂量生理盐水。比较两组产妇镇痛前、镇痛后1 h、3 h、5 h、胎儿娩出时、分娩2 h后的体温情况;比较两组产妇镇痛前、镇痛后3 h、分娩后5 h的白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子α(TNF-α)水平;比较两组产妇第一产程、第二产程视觉模拟(VAS)评分;比较两组新生儿分娩1 min、5 min时阿氏(Apgar)评分;比较两组产妇分娩期间不良反应发生情况和中转剖宫产情况。结果镇痛前、镇痛后1 h,两组产妇的体温比较差异均无统计学意义(P>0.05),而镇痛后3 h、镇痛后5 h、胎儿娩出时、分娩2 h后,研究组产妇的体温分别为(36.9±0.6)℃、(37.0±0.5)℃、(37.1±0.6)℃、(36.5±0.5)℃,明显低于对照组的(37.5±0.7)℃、(37.7±0.8)℃、(37.8±0.9)℃、(37.4±0.7)℃,差异均有统计学意义(P<0.05);镇痛前,两组产妇的IL-6、IL-10、TNF-α水平比较差异均无统计学意义(P>0.05),而镇痛后3 h,两组产妇的IL-6、IL-10、TNF-α水平均明显下降,且研究组分别为(16.2±3.2)pg/mL、(14.4±3.1)pg/mL、(0.51±0.21)pg/mL,明显低于对照组的(21.7±3.6)pg/mL、(17.7±3.3)pg/mL、(0.81±0.30)pg/mL,差异均具有统计学意义(P<0.05),但分娩5 h后,两组产妇的IL-6、IL-10、TNF-α水平均恢复正常,差异均无统计学意义(P<0.05);研究组产妇第一产程、第二产程的VAS评分分别为(1.87±0.75)分、(3.77±0.83)分,明显低于对照组的(4.12±1.43)分、(5.98±1.62)分,差异均有统计学意义(P<0.05);两组新生儿分娩1 min、5 min时的Apgar评分比较差异均无统计学意义(P<0.05);研究组患者的不良反应总发生率和中转剖宫产率分别为3.0%,1.0%,明显低于对照组的15.0%,8.0%,差异均有统计学意义(P<0.05)。结论地塞米松在硬膜外分娩镇痛相关产时发热中的应用,能有效降低产妇发热率和炎症反应,减轻分娩过程的疼痛感,有利于降低产妇分娩中不良反应发生率和中转剖宫产率,且不会增加新生儿风险,安全性高,具有临床应用价值。
Objective To study the application effect of dexamethasone in epidural labor analgesia-related intrapartum fever.Methods A total of 200 delivery woman admitted to Northwest Women's and Children's Hospital from January 2020 to August 2021 were selected as the research objects.According to a random number table method,they were divided into a study group and a control group,with 100 cases in each group.Both groups underwent epidural anesthesia for labor analgesia.The delivery woman in the study group were given epidural first dose(0.1%ropivacaine and 0.5μg/mL sufentanil,10 mL)and 5 mg dexamethasone.The delivery woman in the control group were given epidural first dose(0.1%ropivacaine and 0.5μg/mL sufentanil,10 mL)and 5 mg normal saline.The maternal body temperature before analgesia,1 h,3 h,5 h after analgesia,during fetal delivery,and 2 h after delivery were compared between the two groups.The levels of interleukin-6(IL-6),interleukin-10(IL-10),and tumor necrosis factorα(TNF-α)before and 3 h after analgesia,and 5 h after delivery were compared between the two groups.The visual analogue(VAS)scores of the first and second stages of labor were compared between the two groups.The Apgar scores at 1 min and 5 min after delivery were compared between the two groups.The incidence of adverse reactions and conversion to cesarean section during delivery were compared between the two groups.Results There was no significant difference in the maternal body temperature between the two groups before analgesia and 1 h after analgesia(P>0.05);but at 3 hours after analgesia,5 hours after analgesia,at the time of fetal delivery,and 2 hours after delivery,the body temperature in the study group were(36.9±0.6)℃,(37.0±0.5)℃,(37.1±0.6)℃,(36.5±0.5)℃,which was significantly lower than(37.5±0.7)℃,(37.7±0.8)℃,(37.8±0.9)℃,(37.4±0.7)℃in the control group(P<0.05).Before analgesia,there was no significant difference in the levels of IL-6,IL-10,and TNF-αbetween the two groups(P>0.05);but 3 h after analgesia,the levels of IL-6,IL-10,and TNF-αin the two groups of delivery woman decreased significantly,and the levels in the study group were(16.2±3.2)pg/mL,(14.4±3.1)pg/mL,and(0.51±0.21)pg/mL,which were significantly lower than(21.7±3.6)pg/mL,(17.7±3.3)pg/mL,and(0.81±0.30)pg/mL in the control group(P<0.05);but after 5 h after delivery,the levels of IL-6,IL-10,and TNF-αin the two groups of delivery woman returned to normal,with no statistically significant difference(P<0.05).The VAS scores of the first and second stages of labor in the study group were(1.87±0.75)points and(3.77±0.83)points,which were significantly lower than(4.12±1.43)points and(5.98±1.62)points in the control group(P<0.05).There was no statistically significant difference in Apgar scores between the two groups at 1 min and 5 min after delivery(P<0.05).The total incidence of adverse reactions and the rate of conversion to cesarean section in the study group were 3.0%and 1.0%,which were significantly lower than 15.0%and 8.0%in the control group.Conclusion The application of dexamethasone in epidural labor analgesia-related intrapartum fever can effectively reduce the incidence of fever and inflammatory reactions in pregnant women,alleviate pain during childbirth,help reduce the incidence of adverse reactions during childbirth and the rate of conversion to cesarean section,and will not increase the risk of newborn,which has high safety and clinical application value.
作者
耿娟
周晓娟
周丹丹
GENG Juan;ZHOU Xiao-juan;ZHOU Dan-dan(Department of Anesthesiology,Northwest Women's and Children's Hospital,Xi'an 710061,Shaanxi,CHINA)
出处
《海南医学》
CAS
2023年第12期1710-1713,共4页
Hainan Medical Journal
基金
陕西省卫生健康科研基金项目(编号:2021A013)。
关键词
分娩镇痛
产妇
地塞米松
发热
Labor analgesia
Delivery woman
Dexamethasone
Fever
