手术麻醉对分娩时母婴免疫的影响

Effect of operative delivery and anesthesia on immunity in parturient and newborn

目的探讨围生医学中手术麻醉对分娩时母婴免疫功能的影响。方法正常初产妇分为自然分娩（NL）组、择期手术分娩麻醉（PCS）组、急诊手术分娩麻醉（ECS）组，每组20例，用流式细胞术检测分娩时母体外周血和婴儿脐带衄巾B细胞、T淋巴细胞、NK细胞、NKT细胞、γδT细胞的百分比并进行比较。结果母体血中ECS组的B细胞和NKT细胞明显高于NL组、PCS组；婴儿脐血中PCS组的B细胞、NK细胞和T淋巴细胞CD4^＋／CD8^＋明显低于NC组和ECS组（P〈0．05），γδT细胞显著高于NL组和ECS组（P〈0．01）。结论急诊手术分娩对母体免疫方面的改变与自身应激反应有关，不影响婴儿的细胞免疫状态；择期手术分娩影响婴儿免疫状态。

Objective To evaluate the influence of operative delivery and anesthesia on immunity in parturient and newborns. Methods 60 healthy primiparas were divided into three groups ： natural labor group （ NL group） , elective cesarean delivery group （PCS group） , and emergency cesarean delivery group （ECS group）. Each group included 20 ca- ses. When the children were born, the B cells, T cells, NK cells, NKT cells and γδT cells in the parturient peripheral blood and newborns cord blood were examined by flow cytometry. Results The percentages of B cells and NKT cells in the parturient peripheral blood of ECS group were significantly higher than those in NL group and PCS group. The per- centages of B ceils, NK ceils, T cell subsets CD4 ＋/CD8 ＋ in the newborns cord blood of PCS group were significantly lower than lhose of NL group and ECS group （ P 〈 0.05 ）. The percentage of the γδT cell in newborn cord blood of PCS group were significantly higher than that of NL group and ECS group （P 〈 0.01 ）. Conclusion Changes of immunity in parturient with emergency cesarean delivery may resuh from stress response, and do not affect the cellular immune status in newborns. Elective eeasarean delivery affects the immune status in newborns.