【作者】 罗小玲；

【导师】 陈世彪；

【作者基本信息】 南昌大学 ， 麻醉学， 2008， 硕士

【摘要】 目的:通过观察CSEA分娩镇痛过程中母血T细胞亚群及IL-1β、IL-10的变化,研究CSEA分娩镇痛对母体免疫功能以及Th1/ Th2型细胞因子平衡的影响。方法:选择2007年7月～12月在本院产科分娩的产妇(单胎、头位、初产妇、ASAⅠ级)50例为研究对象,随机分为两组,每组25例,Ⅰ组为腰-硬联合分娩镇痛组,Ⅱ组为无镇痛措施的自然分娩组。CSEA分娩镇痛方法为: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。两组产妇在宫口开大2-3cm(T1)、胎儿娩出时(T2)、分娩后24小时(T3)抽取产妇外周静脉血,用流式细胞仪法检测T细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+),放射免疫法检测皮质醇(CORT)、白介素-1β(IL-1β),酶联免疫吸附法(ELISA)检测白介素-10(IL-10)。并分别记录产程、新生儿Apgar评分以及疼痛视觉模拟评分(VAS)。按入选标准选取25例无宫缩待产产妇(T0)作为上述两组共同的CORT、IL-1β、IL-10、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+基础值对照。结果:(1)第一产程活跃期Ⅰ组比Ⅱ组明显缩短(p﹤0.05),在第二产程、第三产程无差异(p﹥0.05),新生儿Apgar评分组间比较无差异(p﹥0.05)。(2)母血CORT水平在T2时点Ⅰ组明显低于Ⅱ组(p﹤0.01)。(3)随着产程的进行,两组母血IL-1β浓度明显增加(p﹤0.05),在T2时点Ⅰ组明显低于Ⅱ组(p﹤0.01)。(4)母血IL-10水平在T2时点Ⅰ组明显低于Ⅱ组(p﹤0.05)。(5)两组母血CD3~+、CD4~+、CD4~+/CD8~+均有不同程度降低,在T3时点降低显著(P <0.05),且Ⅱ组明显低于Ⅰ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,可能是维持适度Th1/ Th2型细胞因子平衡的一种较好的方法。更多还原

【Abstract】 Objective : This study was designed to investigate the effect of combined spinal-epidural analgesia(CSEA) on immunological function and Th1/Th2 type cytokines balance by observing change in the level of the T-lymphocyte subsets and IL-1βand IL-10 in maternity serum in labor.Methode: Fifty healthy primipara with single birth, vertex present and ASA I between July 2007 and Dec 2007 in the first Affiliated Hospital of Nangchang University School of Medicine who were in spontaneous labor were randomly divided into two subgroups when their cervical dilations were in 2-3cm. In interfering subgroup(n=25), the puncture point of CSEA is at L3-4 interspace, the fentanyl(20μg) was used in lumbar anesthesia, the ropivacaine(0.1%) combined with fentanyl (1μg/ml) was used in epidural analgesia. Blood samples were taken from the mother vein at cervical dilation in 2-3m (T1), fetal disengagement(T2), 24hrs after childbirth (T3). The serum separated from the coagulated blood were stored at -70℃until thawed for cortisol(CORT), IL-1βand IL-10 assay. The flow cytometer method was used to measure T lymphocyte subsets, the radioimmunoassay(RIA) method was uaed to measure CORT and IL-1β, the enzyme linked immunosorbent assay(ELISA) was used to measure IL-10. In addition, Data on labor progress,VAS score and neonatal Apgar score were recorded for each patient. According to selecting standards, the anodinia puerpera(n=25) were controled.Results: (1) In the CSEA group, the active phase in the first stage of labor after analgesia were significantly lower than that in spontaneous delivery group ( P<0.05); There was no difference in the second stage, the third stage and the neonatal Apgar score between the two groups( P>0.05). (2) The level of the CORT in maternity serum of the interfering subgroup were markedly lower than that of the non-interfering one(P<0.05). (3) With the progress of labor, the level of the IL-1βmarkly increased in two groups, moreover, at T2, that of the interfering one were significantly lower, followed by that of the non-interfering one(P<0.01). (4) At T2, in the interfering one, the level of the IL-10 were obviously lower than that in the non-interfering one. (4) In two groups, the levels of the CD3~+、CD4~+、CD4~+/CD8~+ degraded in different degree and significantly decreased at T3 (P<0.05), and that of non-interfering one were obviously lower than that of interfering one(P<0.05).Conclusions: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 cause by pain stress response, which may be a better method to maintain appropriate balance for Th1/Th2 type cytokines.更多还原