Effect Of Epidural Labor Analgesia On Prostaglandin Level And Uterine Muscle Contractility

Object:This study intends to observe the changes of maternal prostaglandin（PG）E₂and oxytocin levels during epidural labor analgesia through the comparison of parturients with parturients without epidural labor analgesia,and analyze their effects on labor and uterine systolic force,so as to provide help for clinical intervention of parturients with epidural labor analgesia.Background:Severe labor pain during labor not only causes pain to the mother,but more importantly,it can lead to a series of pathophysiological and even psychological changes and cause serious adverse consequences,because the severe pain will make the mother in a state of severe stress response.With the national policy promotion ofepidural labor analgesia at the end of 2018,the proportion of epidural labor analgesia is increasing,which has become an important part of the clinical work of the department of anesthesiology.At the same time,due to the increase of epidural analgesic parturient women,its influence on the labor process has been paid more and more attention.The influence of epidural labor analgesia on labor is one of the focus of attention.Methods:A total of 57 expectant mothers were selected.According to their wishes,35cases of parturients who received epidural analgesia were assigned as the experimental group（EA group）,and 22 cases of parturients who did not receive epidural laboranalgesia were assigned as the control group（C group）.All pregnant women who met the inclusion criteria entered this study after the start of labor.The parturient enters the delivery room,and the veins of the upper extremities are opened.The parturients in the EA group went to the operating room for epidural puncture and catheterization.Choose the L2-3 or L3-4 space for the epidural puncture location,give a loading dose of 0.1%ropivacaine+sufentanil 5μg,a total of 10 ml,and connect the epidural analgesic pump:0.08%ropivacaine+0.4μg/ml Shufen 150ml in total,continuously pumped 9.9ml/h,added 8ml/time,locked time 45min.Group C was not given analgesic drugs and gave birth naturally.Such epidural analgesia was given for 45 minutes,and 1 hour after the start of labor,it was about the time when the mother returned to the delivery room.For the two groups of puerperae,T0 was defined as dilation of the cervix to 2 cm after the start of labor,T1 after 1 hour,T2 before the second stage of labor,and T3 immediately after delivery.EA group and C group were collected 10ml of peripheral venous blood at T0,T1 and T2 time points respectively,and 10ml of amniotic fluid was collected from the two groups of parturients at T3 time point.The levels of PGE₂and oxytocin in blood and amniotic fluid were uniformly measured.The two groups recorded the visualanalogue scale（VAS）at T0,T1,and T2 time points,and compared them at the same time points;recorded the uterine contraction strength,interval time,and duration at T0,T1,and T2 time points,and performed them at the same time points respectively.For comparison,the above indicators in the EA group were self-controlled at T0 and T1time points.The concentrations of PGE₂and oxytocin in the blood samples at T0,T1,and T2 were detected respectively,and the differences in PGE₂and oxytocin at the same time points were compared between the two groups,and the correlation betweenchanges in PGE₂and oxytocin in blood samples and changes in uterine musclecontraction were analyzed respectively.The concentrations of PGE₂and oxytocin in T4amniotic fluid were detected,and the differences in PGE₂and oxytocin were compared between the two groups.The amount of oxytocin used,the rate of fetal heart ratevariability,the time of the first stage of labor,and the time of the second stage of labor were compared between the two groups.Results:Compared with group C,there was no significant difference in uterinecontraction intensity,duration,and intermittent time at each time point of T0,T1,and T2 between EA group and C group（Table 2,Table 3,Table 4）,P>0.05;,T1 time point for self-control,there was no significant difference in uterine contraction intensity,duration,and intermittent time（Table 5）,P>0.05.Comparing the VAS scores at T0,T1,and T2 time points between the two groups,there was no significant difference in the VSA scores between the two groups at the T0 time point（Table 6）,P>0.05;there were significant differences in the VSA scores between the two groups at the T1 and T2 time points（Table 6）,P<0.01.There was no significant difference in PGE₂between the two groups at T0,T1,T2,and T3 time points（Table 7）,P>0.05.The change of PGE₂in the two groups of blood samples was positively correlated with the change of uterinemuscle contraction strength（r=0.678,P<0.05）,the change of duration was positively correlated（r=0.759,P<0.05）,and the change of intermittent time was negativelycorrelated（r=-0.807,P<0.05）,that is,the higher the PGE₂concentration,the stronger the uterine contraction intensity,the longer the duration,and the shorter the interval time.There was no significant difference in the degree of oxytocin between the twogroups at T0,T1,T2,and T3 time points（Table 8）,P>0.05.The change of oxytocin in blood samples of the two groups was positively correlated with the change of uterine muscle contraction strength（r=0.380,P<0.05）,the change of duration was positively correlated（r=0.854,P<0.05）,and the change of interval time was negatively correlated（r=-0.761,P<0.05）,that is,the higher the concentration of oxytocin,the greater theintensity of uterine contraction,the longer the duration,and the shorter the interval time.Compared with group C,there was no significant difference in oxytocin usage between the two groups（Table 9）,P>0.05;there was no significant difference in fetal heart rate variability between the two groups（Table 9）,P>0.05;the first The time of labor and the second stage of labor was prolonged,but the difference was not statistically significant（Table 9）,P>0.05.Conclusion:Epidural block labor analgesia has a good analgesic effect on the parturient,has little effect on PGE₂secretion,and has little effect on the labor process,uterinecontraction changes,and fetal heart rate variability,and has high safety.A reliable means of labor analgesia.