分娩镇痛对产妇T细胞亚群的影响

目的观察蛛网膜下隙-硬膜外间隙联合阻滞（CSEA）分娩镇痛时产妇T细胞亚群的变化。方法 5 0例足月产妇随机分为2组,镇痛组（A组）和对照组（C组）各25例。A组行CSEA分娩镇痛。方法 选L3～4间隙为穿刺点,腰麻用药为20μg芬太尼,硬膜外用药为0.1%罗哌卡因＋2μg/mL芬太尼。C组未行分娩镇痛。2组产妇在宫口开大2～3cm（T1）,胎儿勉出时（T2）、分娩后24h（T3）采血,用放免法检测皮质醇,流式细胞仪法检测T细胞亚群CD3＋、CD4＋、CD8＋、CD4＋/CD8＋,并分别记录产程、新生儿Apgar评分以及疼痛视觉模拟评分（VAS）。结果 （1）第一产程活跃期A组比C组明显缩短（P〈0.05）,在第二、三产程、新生儿Apgar评分2组无差异;（2）皮质醇浓度在T2时间点A组明显低于C组（P〈0.05）;（3）2组母血CD3＋、CD4＋、CD4＋/CD8＋均有不同程度降低,在T3时间点降低显著（P〈0.05）,且C组明显低于A组（P〈0.05）。结论 CSEA分娩镇痛可缩短第一产程活跃期,对新生儿Apgar评分无明显影响,能够减轻疼痛等应激反应对产妇免疫功能的抑制。

The Influence of Labor Analgesia on T-lymphocyte Subsets of Maternity

Objective To observe the change of T-lymphocyte subsets of maternity with combined spinal-epidural analgesia（CSEA） Methods 50 cases of full-term mothers were randomly divided into two groups：the interfering group with CSEA （group A） and the control group （group C） 25 cases for each.In interfering group,the puncture point of CSEA is at L3～4 interspace,the fentanyl （20μg） was used in lumbar anesthesia,and the ropivacaine （0.1%） combined with fentanyl （2μg/ml） was used in epidural analgesia.Group C did not line analgesia.Blood samples were taken from the mother vein at cervical dilation in 2～3cm （T1）,fetal disengagement （T2）,24hrs after childbirth （T3）.The radioimmunoassay （RIA） method was used to measure CORT and the flow cytometer method was used to measure T lymphocyte subsetsC D3＋、CD4＋、CD8＋、CD4＋/CD8＋.and meanwhile the labor progress,neonatal Apgar score and VAS score were recorded for each patient respectively.Results （1） In the CSEA group （group A）,the active phase in the first stage of labor after analgesia were significantly lower than that in control group （group C）（P0.05）;there was no difference in the second stage,the third stage and the neonatal Apgar score between the two groups （P0.05）;（2）At T2,the level of the CORT in maternity serum of interfering group were markedly lower than that of control group （P0.05）;（3） In two groups,the levels of the CD3＋、CD4＋、CD4＋/CD8＋ degraded in different degree and significantly decreased at T3（P0.05）,and that in group C were obviously lower than that in group A（P0.05）.Conclusion CSEA could shorten the active delivery phase in the first stage of labor,and has no effect on the neonatal Apgar score.It can alleviate the inhibitive effect on immune function caused by pain stress response.