分娩镇痛方式对孕产妇应激状况和免疫功能及妊娠结局的影响

Effect of Analgesia Mode in Childbirth on Stress status, Immune Function and Pregnancy Outcome

[目的]探讨分娩镇痛方式对孕产妇应激状况、免疫功能及妊娠结局的影响.[方法]164例孕产妇根据分娩镇痛方式的不同随机均分为两组.对照组实施硬膜外分娩镇痛,观察组给予腰硬联合麻醉分娩镇痛.比较两组镇痛效果、产后应激状况、分娩前后免疫功能和妊娠结局.[结果]观察组总镇痛率为87.80％（72/82）,明显高于对照组的69.51％（57/82）（P〈0.05）.观察组患者焦虑自评量表（SAS）和抑郁自评量表（SDS）评分,焦虑和抑郁发生率均低于对照组（P〈0.05）.两组患者分娩前各免疫功能指标的水平比较差异无显著性（P〉0.05）.分娩后两组患者的CD4^＋、CD8^＋、和CD4^＋/CD8^＋水平均下降,IL-6水平均升高（P〈0.05）,且观察组CD4^＋和CD4^＋/CD8^＋水平高于,CD8^＋和IL-6水平均低于对照组（P〈0.05）.观察组剖宫产率为6.10％（5/82）,明显低于对照组的20.73％（17/82）（P〈0.05）.观察组总不良反应发生率明显低于对照组（P〈0.05）.[结论]腰硬联合麻醉分娩镇痛可显著提高镇痛效果,改善患者产后应激状况和免疫功能,且安全可靠.

[Objective]To analyze the effect of analgesia mode during childbirth on stress status, immune function and pregnancy outcome. [Methods] A total of 164 pregnant women were randomly divided into two group according to the different ways of labor analgesia. The control group was given the analgesic measures of epidural delivery, and the observation group was given a combination of lumbar and hard epidural anesthesia for labor analgesia. The analgesic effect, postpartum stress, immune function before and after delivery and pregnancy outcome were compared and analyzed in the two groups. [Results]The total analgesic rate of the ob- servation group was 87.80% （72/82）, which was significantly higher than that of the control group, which was 69.51% （57/82） （ P 〈0.05）. The anxiety self-rating scale （SAS） score and depression self-rating scale （SDS） score of the observation group were all lower than those of the control group, which showed the incidence of anxiety and depression were lower than those of the control group （ P 〈0.05）. There was no significant difference in the level of immune function between the two groups （ P〉0.05）. After delivery, levels of CD4^＋ , CD8^＋ , and CD4^＋/CD8^＋ in the two groups decreased, while IL-6 increased （ P 〈0.05）. The levels of CD4^＋ and CD4^＋/CD8^＋ in the observation group were higher than those in the control group, however, the levels of CD8^＋ and 11.-6 were lower than those in control group （ P〈0.05）. The cesarean section rate in the observation group was 6.10%, which was significantly lower than that in the control group （20.73%） （ P〈0.05）. The incidence of total adverse reactions in the observation group was significantly lower than the control group （ P 〈0.05）. [Conclusion]Combined spinal epidural anesthesia for labor analgesia can significantly improve the analgesic effect, improve postpartum stress and immune function, and improve safety.