腰-硬联合阻滞分娩镇痛对产妇外周血CD3^＋、CD4^＋、CD8^＋细胞的影响

目的观察腰．硬联合阻滞（CSEA）分娩疼痛时对产妇外周血CD3^＋、CIM^＋、CI）8^＋细胞的影响。方法50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，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组不做镇痛处理。两组产妇在宫口开大2-3cm（T1），胎儿娩出时（T2）、分娩后24h（T1）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）与C组比较，A组第一产程活跃期明显缩短[（177．64±67．98）minVS（219．40±67．37）min，t=2．812，P〈0．05]而第二、三产程、新生儿Apgar评分比较差异无统计学意义[A组：（32．92±11．59）min，（7．56±2．47）min，9．204-0．82；C组：（31．44±13．93）min，（7．28±2．25）min，8．84±1．31]（P〉0．05）。（2）皮质醇浓度在T2时点A组[（548．11±75．67）ng／m1]明显低于c组[（789．32±96．07）ng／m1]（P〈0．05）。（3）两组母血CD3^＋、CD4^＋、CD8^＋／CD8’在各时点均有不同程度降低，而且在L时点A组和C组均降低显著（P〈0．05），C组[分别为（48．43±6．46）％，（31．35±8．93）％，（0．96±0．21）％]明显低于A组[分别为（52．38±5．62）％，（36．90±7．91）％，（1．16±0．25）％]（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 combined spinal epidurai analgesia on the level of T lymphocyte subsets in maternity sera in labor

Objective To investigate the effect of combined spinal epidural analgesia （CSEA） on immune function by observing the changed level of T lymphocyte subsets in maternity sera in labor. Meth- otis Fifty healthy primipara with single birth, vertex present and ASA I between July 2007 and Dec 2007 at the first Affiliated Hospital of Nangchang University, who were in spontaneous labor, were randomly di- vided into two subgroups when their cervical dilations were in 2 -3 cm. In interfering subgroup（ n = 25）, the puncture point of CSEA was at L3-4 interspace, the fentanyl （20μg） was used in lumbar anesthesia, the ropivacaine （0. 1% ） combined with fentanyl （2 μg/ml） was used in epidural analgesia. Blood sam- pies were taken from the mother vein at cervical dilation in 2 -3 m （T1）, fetal disengagement（ T2 ）, 24 hrs after childbirth （T3 ）. Flow cytometry was used to measure T lymphocyte subsets, Radi .y （RIA） was used to measure cortisol. In addition, Data on labor progress, VAS score, and neonatal Apgar score were recorded for each patient. Results （1）The active phase in the first stage of labor after analgesia in the CSEA group [ （ 177.64 ±67. 98） min] was significantly lower than that in control group [ （219.40 ± 67.37） mini. No significant difference was found for the active phase in the second stage and the thirdstage, and for the neonatal Apgar score between the CSEA group [ （ 32. 92 ± 11.59） min, （ 7. 56 ± 2. 47 ） min,9. 20 ±0. 82, respectively] and the control group [ （31.44 ± 13.93 ） min, （7. 28 ± 2. 25 ） min, 8. 84 ± 1.31, respectively ]. （2）The level of cortisol in A group [ （ 548. 11 ± 75.67 ） ng/ml ] was significantly low- er than that in C group[ （789. 32 ±96. 07）ng/ml] at T2. （3） In two groups, the levels of the CD3^＋、CD4^＋、CD8^＋ degraded in different degree at each point, more significantly decreased at T3 , and these in C group[ （48.43 ± 6. 46）%, （31.35 ± 8.93 ）%, （0. 96 ± 0. 21 ）%, respectively] were significantly lower than those in A group [ （52. 3 ± 5.62） %, （ 36. 90 ± 7.91 ） %, （ 1.16 ± 0.25 ） %, respectively ]. Conelu- slons CSEA could shorten the active delivery phase in the first stage of labor, and did not affect the neo- natal Apgar score. It can alleviate the inhibitory effect of pain stress response on the immune function.