Objective: To investigate the impact of different doses of ropivacaine combined with spinal epidural anesthesia for maternal and neonatal renin activity, angiotensin II and aldosterone in the cesarean section system. Methods: From June 2015 to April 2017, 140 parturients undergoing cesarean section in the Maternal and Child Health Hospital of Anji County were selected in the research.Combined spinal-epidural ropivacaine were used in all patients during cesarean section anesthesia, and according to different dose of ropivacaine, the patients were divided into A group (8mg), B group(10mg), C group(12mg), D group(15mg), with 35 cases in each group.The analgesic effects of four groups and the changes of each index in the RAAS system of mother and baby in each time period were compared. Results: All fetuses were delivered smoothly.Compared the analgesic effect of four groups, the analgesic effect of IV grade in A group was the lowest percentage [17.14%(6/35)], B, C group had similar proportions [42.86%(15/35), 45.71%(16/35)], D group had the highest proportion [71.42%(25/35)], the maternal proportion of anesthesia effect of IV grade in D group was significantly better than those in A, B, C group, and the differences were statistically significant(χ²=20.90, 5.83, 4.77, all P<0.05). There was no significant change in the level of PRA in each period of A group.The PRA levels in B, C and D group at T1-T3 time were significantly lower than T0(t=14.64, 37.04, 3.97; 15.34, 29.93, 4.73; 25.83, 33, 5.23; 12.47, 8.94, 5.96, all P< 0.05). AT-II in A group at T1-T3 time was decreased, but there was no statistically significant difference compared with T0.AT-II levels in B, C, D group at T1-T3 time were significantly lower than that of T0(t=5.95, 5.98, 3.19; 5.86, 5.54, 4.77; 7.96, 5.47, 6.13; all P<0.05). No significant changes in ALD level of A group in every period of time; ALD levels in B, C, D group at T1-T3 time period were significantly lower than that of T0(t=3.75, 4.92, 2.47; 4.08, 5.77, 2.05; 3.94, 6.13, 3.55, all P<0.05). The fetal umbilical artery and vein of PRA, AT-II and ALD concentration were measured in maternal value range. Conclusion When combined with 10-15 mg ropivacaine for combined spinal epidural anesthesia, the RAAS system of mother and baby is more stable, and the effect of anesthesia and analgesia is better.

Objective:To explore the changes of estrogen, androgen and progesterone in serum of male patients with primary gouty arthritis (pGA) and their possible role in the pathogenesis of gout.Methods:The serum, clinical data and laboratory parameters of 266 patients with PGA [including 93 patients with acute gout (AG), 118 patients with intermittent gout (IG), 55 patients with chronic gout (CG)] and 129 healthy controls (HC) were collected. The serum estradiol (E 2), progesterone (P), testosterone (T) and E 2/T were detected by CMIA Expression level. SPSS 17.0 statistical software was used for analysis, Wilcoxon rank sum test was used for comparison of measurement data between groups, and Spearman correlation analysis was used for correlation analysis between variables. Results:① The level of E 2 and T level in the serum of PGA, AG, IG and CG group was lower than that of the HC group [(30±8) pg/ml, (27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml, (35±10) pg/ml; F=17.770, P<0.05] and [(4.4±1.6) ng/ml, (3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml, (5.8±1.9) ng/ml; F=23.314, P<0.05], but there was no significant difference between HC group and CG group ( P>0.05), The serum E 2 and T levels in AG group were lower than those in IG and CG groups [(27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05] and [(3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml; F=23.314, P<0.05], andthe serum E 2 level in IG group was lower than that in CG group [(31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05). The levels of P and E 2/T in HC group were lower than those in pGA and AG group [(0.24±0.10) ng/ml, (0.27±0.11)ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05] and [(0.006 6±0.002 2) ng/ml, (0.007 6±0.003 2) ng/ml, (0.008 0±0.003 8) ng/ml; F=3.787, P<0.05), while those in IG and CG group were lower than those in AG group [(0.25±0.09) ng/ml, (0.26±0.08) ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05]; ② Spearman correlation analysis showed that E 2 level in pGA group was positively correlated with T and CysC( r=0.310, P<0.01; r=0.164, P=0.008), negatively correlated with MO ( r=-0.133, P=0.030), P level was positively correlated with MO ( r=0.139, P=0.023), T level was positively correlated with Crea and CysC ( r=0.179, P=0.003; r=0.162, P=0.008), negatively correlated with WBC, GR and MO ( r=-0.140, P=0.022; r=-0.173, P=0.005; r=-0.149, P=0.015), E 2/T was positively correlated with apob1 and Glu ( r=0.131, P=0.032; r=0.140, P=0.023). In AG group, E 2 level was positively correlated with T and Crea ( r=0.234, P=0.024; r=0.245, P=0.018), T level was positively correlated with Crea ( r=0.349, P=0.001), and negatively correlated with apob1 ( r=-0.250, P=0.016), and E 2/T was positively correlated with apob1 ( r=0.276, P=0.007). In IG group, E 2 level was positively correlated with T ( r=0.269, P=0.003), and negatively correlated with MO ( r=-0.183, P=0.048), while P level was positively correlated with MO( r=0.204, P=0.027). Conclusion:The expression of E 2 and T in the peripheral blood serum of gout patients decreases significantly, the expression of P and E 2/T increases significantly, and there is a positive correlation between E 2 and T, as well as the inflammatory and glycolipid metabolism indexes of gout patients, suggesting that estrogen, androgen and progesterone may participate in the pathogenesis of gout by regulating the inflammation and metabolism of gout.