硬膜外分娩镇痛对产妇T细胞亚群及细胞因子平衡的影响

目的 分析硬膜外分娩镇痛对产妇T细胞亚群及细胞因子平衡的影响.方法 选择2014年10月至2015年12月足月产妇56例,以数字随机表法均分到2组,每组28例.对照组为无镇痛的自然分娩,观察组采用硬膜外分娩镇痛.分别在T1(潜伏期末)、T2(宫口开全时)、T3(胎儿娩出时)进行疼痛视觉模拟(VAS)评分;记录产妇第一产程活跃期时间,第二、三产程时间及新生儿Apgar评分;并于T1、T2、T3时检测产妇皮质醇、IL-1β、IL-10及T细胞亚群水平.结果 观察组第一产程活跃期明显短于对照组(P<0.05),2组产妇的第二、三产程时间及新生儿Apgar评分无差异;观察组皮质醇水平在T2时明显低于对照组(P<0.05);2组产妇母血CD+3、CD+4、CD+4/CD+8均有不同程度降低,观察组在T3时T细胞亚群下降程度明显低于对照组(P<0.05).结论 硬膜外分娩镇痛能够减轻疼痛等应激反应对产妇免疫功能的抑制,可维持适度Th1/Th2型细胞因子平衡.

Effects of epidural labor analgesia on the balance of T cell subsets and cytokines of parturients

Objective To investigate the effect of epidural labor analgesia on the balance of T cell subsets and cytokines of parturients.Methods Fifty-six term birth parturients who were admitted in our hospital from October 2014 to December 2015 were divided into two groups according to random number table:control group (n=28) and observation group (n=28).The parturients in control group underwent spontaneous delivery, however, the parturients in observation group received epidural labor analgesia.The visual analogue score (VAS) was performed in T1 (latent period),T2 (at full dilatation),T3 (fetal disengagement),and the active duration in the first stage of labor was recorded,moreover, the duration of second stage of labor and third stage of labor as well as neonatal Apgar score were recorded.Besides the levels of cortisol, IL-1β,IL-10 and T cell subsets of parturients were detected in T1,T2,T3.Results The active duration in the first stage of labor in observation group was significantly shorter than that in control group (P<0.05),however,tere were no significant differences in the duration of second stage of labor and third stage of labor as well as neonatal Apgar score between two groups (P>0.05).The levels of cortisol in T2 in observation group were significantly lower than those in control group (P<0.05),moreover, the levels of CD+3,CD+4 and CD+4/CD+8 were decreased at different extent in both groups, besides, the decrease degree of T cell subsets in T3 in observation group was significantly lower than that in control group (P<0.05).Conclusion The epidural labor analgesia can relieve pain and the other stress responses to improve maternal immune function suppression,which can maintain balance of Th1/Th2.