Abstract：Objective To investigate the effect of different doses of dexmedetomidine on epidural labor analgesia for mothers and infants based on MAPK/ERK signaling pathway. Methods 200 puerperae who met the inclusion criteria were randomly divided into: non-epidural analgesia group (group C), epidural analgesia combined with normal saline group (group N), epidural analgesia combined with intravenous injection of dexamethasone Detomidine 0.5μg/kg group (group D1), epidural analgesia combined with intravenous injection of dexmedetomidine 0.75μg/kg group (D2 group) and epidural analgesia combined with intravenous injection of dexmedetomidine 1μg/kg group (D3 group), 40 cases in each group. The Ramsay sedation scale and VAS score were used to record the pain scores of sedatives in each group. The volume method was used to detect the amount of vaginal bleeding at 2 h postpartum. RT-PCR was used to detect the mRNA and protein expressions of Raf, ERK, CREB and DYN in the placenta. A rat pregnancy model was established, and the successfully modeled pregnant rats were randomly divided into 4 groups, namely blank control group C, dexmedetomidine 50 μg/kg (group D1), dexmedetomidine 100 μg/kg (group D2) ), dexmedetomidine 200 μg/kg (group D3). The pain threshold of rats during childbirth was determined by hot water tail flick method, and the Richmond agitation and sedation scale was used for scoring; RT-PCR and WB were used to detect the parietal lobe region of gray matter, spinal cord lumbar enlargement, and myometrium tissue Raf, ERK, Changes in mRNA and protein content of CREB and DYN. Results TResults There were no significant differences in age, BMI, gestational week, cervical dilation, postpartum vaginal bleeding volume, pre-analgesic Ramsay score, pre-analgesic VAS score and neonatal Apgar score among all groups. The Ramsay score in T1-T3 in D1-D3 group was higher than that in N group, the VAS score was lower than that in N group, the mRNA of Raf, ERK and CREB in D1-D3 group was significantly lower than that in N and C group, and the mRNA was significantly higher than that in N and C group, with statistical significance. In the rat pregnancy model, compared with group C, administration of 100μg/kg and 200 μg/kg dexmedetomidine increased tail flick latency, Richmond agitation sedation score was lower than group C. Dexmedetomidine group decreased the mRNA and protein contents of MAPK/ERK signaling pathway in the parietal region of brain gray matter, lumbar enlargement of spinal cord and myometrium of rats, and the differences were statistically significant. Conclusion Dexmedetomidine is used for epidural labor analgesia. By reducing the expression of MAPK/ERK signaling pathway, it can effectively relieve labor pain without obvious maternal.
[1] HE LI. hydro-acupuncture analgesia on pain and birth process time in labor analgesia[J]. Chinese and foreign women's and children's health, 2011, 19(8): 159-160. [2] WEN X, HUANG B, LIANG X.Effect of ropivacaine and sufentanil in epidural labor analgesia[J]. Am J Transl Res, 2021, 13(6): 7001-7007. [3] ABDALLA W, AMMAR MA, THARWAT AI.Combination of dexmedetomidine and remifentanil for labor analgesia: a double-blinded, randomized, controlled study[J]. Saudi J Anaesth, 2015, 9(4): 433-438. [4] Li G, Wang H, Qi X, et al.Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial[J]. J Int Med Res, 2021, 49(4): 300060521999534. [5] HU CIXIAN, REN QIUSHENG, WANG HONG, et al.Clinical study of dexmedetomidine assisted epidural nerve block in painless delivery[J]. China modern doctor, 2014, 57: 58-61. [6] 杨海扣, 周静, 拾翠翠, 等. 右美托咪定复合罗哌卡因在乳腺癌术后镇痛中的应用[J]. 广东医学, 2017, 38(3): 466-467. [7] HUANG C T, CHEN S H, LIN S C, et al.Erythropoietin reduces nerve demyelination, neuropathic pain behavior and microglial MAPKs activation through erythropoietin receptors on Schwann cells in a rat model of peripheral neuropathy[J]. Glia, 2018, 66(11): 2299-2315. [8] 蒋秋燕, 蒋桂秀, 王梦莹, 等. 基于MAPK/p38信号通路探讨灵龟八法开穴电针对产妇分娩的镇痛效应及其作用机制[J]. 中华中医药杂志 (原中国医药学报), 2019, 34(1): 91-94. [9] VENKATA HG, PASUPULETI S, PABBA UG, et al.A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section[J]. Saudi J Anaesth, 2015, 9: 122-127. [10] NIE Y, LIU Y, LUO Q, et al.Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia: a randomised, placebo-controlled study[J]. European Journal of Anaesthesiology, 2014, 31(4): 197-203. [11] MITRA S, ARORA J, AHUJA V, et al.Combined spinal-epidural for labor analgesia with low-dose bupi-vacaine but without any opioid in the spinal component: can we improve upon the traditional[J]. Acta Anaesthesiologica Belgica, 2015, 66: 9-15. [12] KUMARI K, GOMBAR S, KAPOOR D, et al.Clinical study to evaluate the role of preoperative dexmedetomidine in attenuation of hemodynamic response to direct laryngoscopy and tracheal intubation[J]. Acta Anaesthesiol Taiwan, 2015, 26: S1875-S4597. [13] BILOTTA F, ROSA G.Anesthesia for awake neurosurgery[J]. Curr Op in Anaesthesiol, 2009, 22: 560-565. [14] MU JY, CHEN XG.The progress of the study on the mitogen-activated protein kinase pathways[J]. Chin Bull Life Sci, 2002, 14: 208-211. [15] KELLEHER RJ, GOVINDARAJAN A, JUNG HY, et al.Translational control by MAPK signaling in long-term synaptic plasticity and memory[J]. Cell, 2004, 116(3): 467-479. [16] MIKA J, ZYCHOWSKA M, POPIOLEK-BARCZYK K, et al.Importance of glial activation in neuropathic pain[J]. European journal of pharmacology, 2013, 716(1-3): 106-119. [17] WAN J, QIU Z, DING Y, et al.The Expressing Patterns of Opioid Peptides, Anti-opioid Peptides and Their Receptors in the Central Nervous System Are Involved in Electroacupuncture Tolerance in Goats[J]. Front Neurosci, 2018, 12: 902. [18] GINTZLER AR, LIU NJ.Harnessing endogenous opioids for pain relief: Fantasy vs reality[J]. J Opioid Manag, 2019, 16(1): 67-72.
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