摘要
目的:探究硬膜外镇痛(PCEA)下产妇血清C反应蛋白(CRP)、一氧化氮(NO)水平与不良分娩结局关系。方法:选取2020年9月-2022年11月本院正常分娩并选择PCEA的产妇100例为PCEA组,无麻醉正常分娩产妇100例为对照组。PCEA组依据最终分娩结局分为良好组和不良组。免疫比浊法测定CRP,硝酸还原酶法测定NO。采用多因素logistic回归分析影响PCEA下产妇分娩结局的可能因素;CRP、NO对产妇不良分娩结局的预测价值采用受试者工作特征(ROC)曲线评估。结果:宫口开4cm时、宫口全开时,PCEA组血清CRP(17.32±5.66 mg/ml)、VAS评分(2.38±0.79分)低于对照组(34.39±7.22 mg/ml、7.51±2.66分),NO水平(6.23±1.79 pg/ml)高于对照组(5.62±1.81 pg/ml),且分娩结局良好组血清CRP水平低于不良组、NO水平高于不良组(均P<0.05);ROC曲线显示,CRP预测不良分娩结局预测的曲线下面积(AUC)为0.877,截断值18.59mg/ml,敏感度76.9%、特异性91.8%;NO预测不良分娩结局的AUC为0.842,截断值6.00pg/ml,敏感度94.9%、特异性66.7%;二者联合预测的AUC(0.925)高于二者单独预测,敏感度92.3%、特异性87.1%;回归分析显示,CRP升高、NO降低是不良分娩结局的独立危险因素(P<0.05)。结论:PCEA下不良分娩结局产妇血清CRP、NO高表达、NO低表达,表达异常与分娩结局有关,二者联合预测PCEA产妇不良分娩结局价值较高。
Objective:To investigate the correlation between the levels of serum C-reactive protein(CRP)and nitric oxide(NO)of women with patient controlled epidural analgesia(PCEA)and their adverse delivery outcomes.Methods:A total of 100 women who had delivered normally and with PCEA used were selected in study group from September 2020 to November 2022,including the women with normal delivery outcomes in group A and the women with adverse delivery outcomes in group B.Another 100 women who had delivered normally and without labor analgesia were selected in control group during the same period.The CRP level of the women in these groups was measured by immunoturbidimetry,and the NO level of the women in these groups was measured by nitrate reductase method.Multivariate logistic regression was used to analyze the possible factors affecting the delivery outcomes of the women with PCEA.The predictive values of the CRP and NO levels of the women for their adverse delivery outcomes were evaluated by receiver operating characteristic(ROC)curve.Results:The serum CRP level(17.32±5.66 mg/ml)and VAS score(2.38±0.79 points)of the women in the study group from the cervical dilation 4cm to full dilation were significantly lower than those(34.39±7.22 mg/ml and 7.51±2.66 points)of the women in the control group,and the level of NO(6.23±1.79 pg/ml)of the women in the study group was significantly higher than that(5.62±1.81 pg/ml)of the women in the control group.The serum CRP level of the women in group A was significantly lower than that of the women in group B,and the level of NO of the women in group A was significantly higher(all P<0.05).ROC curve showed that the area under the curve(AUC)of the CRP level of the women for predicting their adverse delivery outcomes was 0.877,the cut-off value of which was 18.59mg/ml,the sensitivity of which was 76.9%,and the specificity of which was 91.8%.The AUC of the NO level of the women for predicting their adverse delivery outcomes was 0.842,the cut-off value of which was 6.00pg/ml,the sensitivity of which was 94.9%,and the specificity of which was 66.7%.The AUC of the combined CRP and NO levels of the women for predicting their adverse delivery outcomes was 0.925,which was significantly higher than that of the CRP level or the NO level alone,with the sensitivity of 92.3% and the specificity of87.1%.Regression analysis showed that the increased CRP level and the decreased NO level of the women were the independent risk factors for their adverse delivery outcomes(P<0.05).Conclusion:The women with adverse delivery outcomes who had received PCEA have the high expression level of serum CRP and the low expression level of serum NO,both of which are correlated with the delivery outcomes of the women.The combined CRP and NO levels of the women with PCEA for predicting their adverse delivery outcomes have higher value.
作者
吴志福
方秀春
江小亚
WU Zhifu;FANG Xiuchun;JIANG Xiaoya(Funan County People's Hospital,Fuyang,Anhui Province,236300)
出处
《中国计划生育学杂志》
2023年第11期2630-2634,共5页
Chinese Journal of Family Planning
关键词
硬膜外分娩镇痛
C反应蛋白
一氧化氮
不良分娩结局
预测
Epidural analgesia in labrr
C-reactive protein
Nitric oxide
Adverse delivery outcomes
Prediction
