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
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摘要
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。
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 of278 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(167cases) 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(hsCRP),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.
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 of278 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(167cases) 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(hsCRP),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.
引文
[1]侯英英,刘晓云.拉玛泽呼吸减痛分娩法对产妇分娩疼痛及妊娠结局的影响[J].河北医学,2015,21(5):757-761.
[2]房建,赵继蓉.小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用[J].中华全科医学,2018,16(2):264-267.
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[4]王向东,张少卿,周玉梅,等.不同时机双管硬膜外分娩镇痛对母婴影响的比较[J].黑龙江医学,2015,39(4):352-354.
[5]董斌,冯春,姜山,等.不同给药模式在瑞芬太尼静脉分娩镇痛中的应用[J].上海医学,2016,39(8):470-475.
[6]黄遐,杨娟,杨永秀.分娩镇痛研究进展[J].国际妇产科学杂志,2017,44(2):197-201.
[7]王智慧,陈文殊,李宇,等.硬膜外阻滞分娩镇痛下第二产程时长对新生儿结局的影响[J].现代妇产科进展,2017,26(3):219-221,224.
[8]LIN R,TAO Y,YU Y,et al.Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia:A retrospective study[J].PLo S One,2014,9(11):e112283.
[9]应震阳.全产程硬膜外阻滞麻醉分娩镇痛的临床疗效观察[J].浙江临床医学,2015,17(9):1621-1622.
[10]皮治兵,林海,徐旭仲.不同剂量右美托咪定对老年腹腔镜手术患者镇痛与应激及免疫功能的影响分析[J].中国临床药理学杂志,2015,31(17):1709-1712.
[11]阳平贵,吴怀勇,吴俊英.分娩镇痛注射方式对产妇血清IL-6、TNF-α及T淋巴细胞亚群水平的影响[J].现代仪器与医疗,2016,22(6):63-66.
[12]胡彦艳,秦丹丹,马利,等.舒芬太尼硬膜外超前镇痛对妇科手术患者T细胞亚群CD4+、CD8+的影响[J].实用医学杂志,2014,30(13):2183-2184.
[13]林兴喆,陈启忠,李君.腰-硬联合分娩镇痛中辅助使用舒芬太尼的临床研究[J].中国妇幼保健,2016,31(14):2966-2968.
[14]徐晓义,褚国强,季永.腰-硬联合阻滞腰麻后硬膜外镇痛时机对分娩镇痛的影响[J].临床麻醉学杂志,2015,31(2):154-157.
[15]杨豪.罗哌卡因与布比卡因在无痛分娩中的镇痛效果及对产妇应激反应的影响[J].药物评价研究,2017,40(10):1468-1471.
[16]廖永强,夏洪娇,刘剑荣,等.系统性红斑狼疮患者抗磷脂抗体与低水平补体C3、C4的关系[J].免疫学杂志,2016,32(12):1053-1057.
[17]昝琦,刘欣,逄越,等.补体C3结构与功能研究进展[J].中国免疫学杂志,2014,30(4):549-553.
[18]刘玉秋,王彬,王梓,等.分娩镇痛对孕产妇血清补体C3、C4及C反应蛋白的影响[J].中国妇产科临床杂志,2016,17(2):144-146.
[19]徐淑稳,房桂英,张霞,等.C-反应蛋白在剖宫产术后监测中的临床意义[J].实用预防医学,2016,23(6):705-707.
[20]马超,韩维田,冯文华.反复流产患者主动免疫治疗前后T淋巴细胞封闭效率比较[J].中华全科医学,2017,15(4):571-573.
[21]李姝,车向明,徐铭军,等.脊椎-硬膜外联合阻滞分娩镇痛对妊娠期高血压产妇IL-2、TNF-α及血压的影响[J].北京医学,2015,37(7):658-661.
[22]王大伟,王保国,刘长宝.不同剂量罗哌卡因复合舒芬太尼腰-硬联合阻滞在产程潜伏期分娩镇痛的效果[J].临床麻醉学杂志,2015,31(6):538-542.
[23]唐文昌,邹素姣,李信安,等.罗哌卡因不同浓度及容量在硬膜外术后镇痛的临床研究[J].中国药物经济学,2014,9(4):58-59.
[24]刘礼胜,钱伟民,李荣,等.地佐辛复合低浓度罗哌卡因硬膜外自控分娩镇痛在无痛分娩中的应用[J].中国药房,2014,25(36):3426-3428.
[25]钟鸣,徐旭仲,黄敏.右美托咪定复合罗哌卡因硬膜外自控镇痛在无痛分娩中有效性的临床对照研究[J].浙江创伤外科,2017,22(4):815-817.
[2]房建,赵继蓉.小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用[J].中华全科医学,2018,16(2):264-267.
[3]KARHADE S S,SARDESAI S P.0.2%ropivacaine with fentanyl in the management of labor analgesia:A case study of 30 parturients[J].Anesth Essays Res,2015,9(1):83-87.
[4]王向东,张少卿,周玉梅,等.不同时机双管硬膜外分娩镇痛对母婴影响的比较[J].黑龙江医学,2015,39(4):352-354.
[5]董斌,冯春,姜山,等.不同给药模式在瑞芬太尼静脉分娩镇痛中的应用[J].上海医学,2016,39(8):470-475.
[6]黄遐,杨娟,杨永秀.分娩镇痛研究进展[J].国际妇产科学杂志,2017,44(2):197-201.
[7]王智慧,陈文殊,李宇,等.硬膜外阻滞分娩镇痛下第二产程时长对新生儿结局的影响[J].现代妇产科进展,2017,26(3):219-221,224.
[8]LIN R,TAO Y,YU Y,et al.Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia:A retrospective study[J].PLo S One,2014,9(11):e112283.
[9]应震阳.全产程硬膜外阻滞麻醉分娩镇痛的临床疗效观察[J].浙江临床医学,2015,17(9):1621-1622.
[10]皮治兵,林海,徐旭仲.不同剂量右美托咪定对老年腹腔镜手术患者镇痛与应激及免疫功能的影响分析[J].中国临床药理学杂志,2015,31(17):1709-1712.
[11]阳平贵,吴怀勇,吴俊英.分娩镇痛注射方式对产妇血清IL-6、TNF-α及T淋巴细胞亚群水平的影响[J].现代仪器与医疗,2016,22(6):63-66.
[12]胡彦艳,秦丹丹,马利,等.舒芬太尼硬膜外超前镇痛对妇科手术患者T细胞亚群CD4+、CD8+的影响[J].实用医学杂志,2014,30(13):2183-2184.
[13]林兴喆,陈启忠,李君.腰-硬联合分娩镇痛中辅助使用舒芬太尼的临床研究[J].中国妇幼保健,2016,31(14):2966-2968.
[14]徐晓义,褚国强,季永.腰-硬联合阻滞腰麻后硬膜外镇痛时机对分娩镇痛的影响[J].临床麻醉学杂志,2015,31(2):154-157.
[15]杨豪.罗哌卡因与布比卡因在无痛分娩中的镇痛效果及对产妇应激反应的影响[J].药物评价研究,2017,40(10):1468-1471.
[16]廖永强,夏洪娇,刘剑荣,等.系统性红斑狼疮患者抗磷脂抗体与低水平补体C3、C4的关系[J].免疫学杂志,2016,32(12):1053-1057.
[17]昝琦,刘欣,逄越,等.补体C3结构与功能研究进展[J].中国免疫学杂志,2014,30(4):549-553.
[18]刘玉秋,王彬,王梓,等.分娩镇痛对孕产妇血清补体C3、C4及C反应蛋白的影响[J].中国妇产科临床杂志,2016,17(2):144-146.
[19]徐淑稳,房桂英,张霞,等.C-反应蛋白在剖宫产术后监测中的临床意义[J].实用预防医学,2016,23(6):705-707.
[20]马超,韩维田,冯文华.反复流产患者主动免疫治疗前后T淋巴细胞封闭效率比较[J].中华全科医学,2017,15(4):571-573.
[21]李姝,车向明,徐铭军,等.脊椎-硬膜外联合阻滞分娩镇痛对妊娠期高血压产妇IL-2、TNF-α及血压的影响[J].北京医学,2015,37(7):658-661.
[22]王大伟,王保国,刘长宝.不同剂量罗哌卡因复合舒芬太尼腰-硬联合阻滞在产程潜伏期分娩镇痛的效果[J].临床麻醉学杂志,2015,31(6):538-542.
[23]唐文昌,邹素姣,李信安,等.罗哌卡因不同浓度及容量在硬膜外术后镇痛的临床研究[J].中国药物经济学,2014,9(4):58-59.
[24]刘礼胜,钱伟民,李荣,等.地佐辛复合低浓度罗哌卡因硬膜外自控分娩镇痛在无痛分娩中的应用[J].中国药房,2014,25(36):3426-3428.
[25]钟鸣,徐旭仲,黄敏.右美托咪定复合罗哌卡因硬膜外自控镇痛在无痛分娩中有效性的临床对照研究[J].浙江创伤外科,2017,22(4):815-817.