| Combined spinal-epidural analgesia is the most effective method of labor analgesia. It minimize the disadvantages of spinal and epidural analgesia. It has some advantages including excellent analgesia, rapid onset, lower total drug dosage, minimal motor block and easier time control. There are few studies about the influence of CSEA on labor progress, especially the studies about the influence of CSEA on uterine contraction, and there is no report about it up to now. The objective of this study is to evaluated the influence of CSEA on labor progress by observing the intensity of uterine contraction, fetal heart rate changes and the progress of labor compared with the changes of spontaneous labor.Interlerkin-6 is a pleiotropic proinflammatory cytokine and an important mediator of immune system and endocrine system. IL-6 levels increase after tissue injure, sever pain, stress and inflammation. The over-high IL-6 levels would breakdown the balance between proinflammatory cytokine and antiinflammatory cytokine and suppress the cellular immunity and lead to turbulence of the immunological function. There are no reports about the influence of CSEA on the serum IL-6 up to now. The objective of this study is to evaluate the influence of CSEA labor analgesia on serum IL-6 of maternity and neonate, the relationship between IL-6 and labor pain and the influence of IL-6 on uterine contraction by measuring the serum IL-6 of maternity and neonate pre-CSEA and post-CSEA.Nitric oxide (NO) has wide biological effect. The modulation of NO on feto-placental circulation is more noticeable. NO can dilate umbilical and placenta! blood vessels. It can2002decrease the resistance of feto-placental circulation and make the fetus have enough blood oxygen supply. Lower NO is the most important factor to maintain the uterine contraction in vivo, and NO levels decrease along with the progress of the labor. NO. So far there is no report about the changes of NO levels after CSEA labor analgesia. The objective of this study is to evaluate the influence of CSEA labor analgesia on the NO levels of maternity and neonate and the relationship between the NO and labor pain and the influence of NO on uterine contraction.Materials and methods: Fifty healthy nulliparous in spontaneous labor with singleton.vetex. full-term fetus. -----.ASA I -II were enrolled when their cervical dilation in 3-4cm inZhejiang Women's Hospital between Mar 2001 and July 2001. The patients were randomly assigned to CSEA labor analgesia group(n = 25) or spontaneous delivery group (n = 25). The CSEA's puncture point is at L2-3 interspace . It's spina! drug is 3.75mg ropivacaine combined with 25ug fentanyl and epidural drug is 0.1% ropivacaine combined with lug ml fentanyl. Both groups" patients were routinely monitored with electronic FHR and uterine contraction monitoring for 30min before and after the time at enrolling. Data on labor progress and outcome were recorded for each patient. Blood samples were taken from the mother vein at cervical dilation at 3-4cm (time at enroll), full cervical dilation, 2h postpartum; neonatal samples were taken at birth (cord blood vein). The serum disintegrated from the coagulated blood were stored at -SOC until thawed for IL-6 and NO assay. Statistical analysis included T test and X test. Statistical significance was assumed when P<0.05 .Results: (1) The uterine contraction's intensity and cervical dilation rate after analgesia in the CSEA group were significantly higher than the spontaneous delivery group (P<0.05); The second stage of labor in the CSEA group was longer than the spontaneous delivery group (P<0.05); There was no difference between the two groups in whole period of labor, Cesarean section rate and instrumental vaginal delivery rate. (2) The serum IL-6 levels of maternity and neonate in CSEA group were significantly lower than the spontaneous delivery group at full cervical dilation and 2h postpartum (P<0.01). (3) The serum NO levels of maternity and neonatein CSEA group were significantly higher... |
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