硬膜外分娩镇痛对产妇免疫功能的影响分析

Effect of epidural labor analgesia on maternal immune function

目的探讨硬膜外分娩镇痛对产妇免疫功能的影响。方法选取2017年6月至2018年10月间在本院住院分娩的足月产妇112例,随机分为观察组与对照组,每组各56例。观察组给予硬膜外分娩镇痛,对照组不采取任何镇痛措施。分别于潜伏期末、子宫颈全开、胎儿娩出时进行视觉模拟评分法(VAS)评分;记录产妇第一产程活跃期、第二产程、第三产程时间,进行新生儿Apgar评分;酶联免疫吸附法检测白细胞介素(IL)-1β、IL-10、皮质醇水平,流式细胞术检测T细胞亚群水平。结果潜伏期末两组产妇的VAS评分之间差异无统计学意义(P>0.05);子宫颈全开、胎儿娩出时观察组产妇VAS评分低于对照组,差异有统计学意义(P<0.01)。观察组产妇第一产程活跃期短于对照组,差异有统计学意义(P<0.01);第二产程、第三产程时间以及新生儿Apgar评分在两组间差异无统计学意义(P>0.05)。胎儿娩出时两组产妇IL-1β、IL-10、皮质醇水平明显低于潜伏期末,差异有统计学意义(P<0.05);子宫颈全开时观察组产妇IL-10、皮质醇水平低于潜伏期末,对照组产妇皮质醇高于潜伏期末,差异有统计学意义(P<0.05)。观察组产妇子宫颈全开时IL-1β、IL-10、皮质醇水平低于对照组,差异有统计学意义(P<0.05)。胎儿娩出时两组产妇CD3+、CD4+、CD4+/CD8+低于潜伏期末,差异有统计学意义(P<0.05);胎儿娩出时观察组产妇CD3+、CD4+、CD4+/CD8+高于对照组,差异有统计学意义(P<0.05)。结论硬膜外分娩镇痛可通过减轻疼痛感来降低应激反应,在缩短产程,维持T细胞亚群和细胞因子平衡方面发挥促进作用。

Objective To investigate the effect of epidural labor analgesia on maternal immune function.Methods 112 full-term pregnant women who delivered in our hospital from June 2017 to October 2018 were randomly divided into observation group and control group,56 cases in each group.The observation group was given epidural labor analgesia,while the control group did not take any analgesic measures.Visual analogue scale(VAS)was used at the end of latency,cervical opening and fetal delivery respectively.The active stage of the first stage of labor,the second stage of labor and the third stage of labor were recorded,and the Apgar score of the newborn was performed.The levels of interleukin(IL)-1β,IL-10 and cortisol were detected by immunosorbent assay.T cell subsets were detected by flow cytometry.Results There was no significant difference in VAS score between the two groups at the end of latency(P>0.05).The VAS score of the observation group was significantly lower than that of the control group at the time of cervical opening and fetal delivery(P<0.01).The active stage of the first stage of labor in the observation group was significantly shorter than that in the control group(P<0.01),and there was no significant difference in the second stage of labor,the third stage of labor and the Apgar score of the newborn between the two groups(P>0.05).The levels of IL-1 beta,IL-10 and cortisol in the two groups were significantly lower than those at the end of latency(P<0.05);the levels of IL-10 and cortisol in the observation group were significantly lower than those at the end of latency(P<0.05),while the levels of cortisol in the control group were significantly higher than those at the end of latency(P<0.05).The levels of IL-1β,IL-10 and cortisol in the observation group were significantly lower than those in the control group(P<0.05).CD3+,CD4+,CD4+/CD8+in the two groups were significantly lower than those at the end of the latency period(P<0.05);CD3+,CD4+,CD4+/CD8+in the observation group were significantly higher than those in the control group at the time of fetal delivery(P<0.05).Conclusion Epidural labor analgesia can reduce stress response by reducing pain,and play a promoting role in shortening labor process and maintaining the balance of T lymphocyte subsets and cytokines.