硬膜外分娩镇痛对产妇炎症因子、补体及免疫功能的影响分析

目的探讨硬膜外分娩镇痛对产妇炎症因子、补体及T淋巴细胞(CD3^+、CD4^+、CD4^+/CD8^+)的影响,并分析其对免疫功能的影响。方法选取2015年2月—2017年2月宁波大学医学院附属医院妇产科收治的278例待产孕妇,按照是否自愿接受分娩镇痛分为观察组167例和对照组111例,观察组采用硬膜外分娩镇痛,对照组不采取任何镇痛措施,分别在宫口开至2～3 cm时(T1)、宫口开全时(T2)、胎儿分娩后(T3)、分娩后24 h(T4)观察2组产妇疼痛视觉模拟评分(VAS)、IL-1β、IL-6、超敏C反应蛋白(hs-CRP)、补体C3、补体C4、CD3^+、CD4^+、CD4^+/CD8^+、收缩压(SBP)、舒张压(DBP)、心率(HR)、产程时间及新生儿1 min Apgar评分的变化情况。结果观察组T2、T3、T4时的VAS评分较T1明显降低(均P<0.05),且观察组明显低于对照组(均P<0.05);2组产妇T2、T3、T4时刻的IL-1β、IL-6、hs-CRP水平较T1时刻均明显升高(均P<0.05),且观察组明显低于对照组(均P<0.05);2组产妇T2、T3、T4时刻的补体C3、C4水平较T1时刻明显降低(均P<0.05),且观察组明显高于对照组(均P<0.05);2组产妇T2、T3、T4时刻的CD3^+、CD4^+、CD4^+/CD8^+均明显下降(均P<0.05),且观察组明显高于对照组(均P<0.05);2组产妇各时刻SBP、DBP、HR比较差异无统计学意义(均P>0.05);2组产妇第一、第二、第三产程时间及新生儿1 min Apgar评分比较差异无统计学意义(均P>0.05)。结论分娩镇痛可明显减轻产妇疼痛,降低炎症反应,改善补体和T淋巴细胞水平,进一步改善免疫功能。

Effect of labor Analgesia on Inflammatory Factors,Complement and Immune Function of Parturient

Objective To investigate the effect of labor analgesia on inflammatory factors, complement and T lymphocytes (CD3+, CD4+, CD4+/CD8+) of parturient, and analyze its effect on immune function. Methods A total of 278 pregnant women were selected in department of obstetrics and gynecology of affiliated hospital of medical college of Ningbo university from February 2015 to February 2017, those pregnant women were divided into observation group (167 cases) and control group (111 cases) according to whether they were willing to receive labor analgesia. The observation group was treated with epidural labor analgesia, the control group did not take any analgesic measures. At the time of the cervix was open to 2-3 cm (T1), the cervix was full opened (T2), after the childbirth (T3) and 24 hours after delivery (T4), the visual analogue scale (VAS) scores, the levels of IL-1β, IL-6, hypersensitive C-reactive protein (hs-CRP), complement C3, complement C4, CD3+, CD4+, CD4+/CD8+, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), duration of labor and 1 min Apgar score of newborn in the two groups were observed. Results Compared with T1, the VAS scores of other time (T2-T4) in observation group decreased significantly (all P<0.05), and the VAS scores of observation group were significantly lower than those of control group (all P<0.05). Compared with T1, the levels of IL-1β, IL-6 and hs-CRP of other time (T2-T4) in two groups increased significantly (all P<0.05), and the levels of observation group were significantly lower than those of control group (all P<0.05). Compared with T1, the levels of complement C3 and C4 of other time (T2-T4) in two groups decreased significantly (all P<0.05), and the levels of observation group were significantly higher than those of control group (all P<0.05). Compared with T1, the levels of CD3+, CD4+, CD4+/CD8+ of other time (T2-T4) in two groups decreased significantly (all P<0.05), and the levels of observation group was significantly higher than those of control group (all P<0.05). There was no significant difference in SBP, DBP and HR between the two groups at each time (all P>0.05); There was no significant difference in the time of first, second and third labor and the Apgar score of 1 min in neonates between the two groups (all P>0.05). Conclusion Labor analgesia can significantly reduce pain and inflammation of parturient, improve the levels of complement and T lymphocytes, further improve the immune function.