不同麻醉方法对高龄非初产妇机体免疫功能的影响分析

Influence of different anesthesia methods on immune function of senile puerpera

目的:分析不同麻醉方法对高龄产妇机体免疫功能的影响。方法:回顾性收集2016年12月~2018年12月在我院行剖宫产的81例高龄非初产妇,依据麻醉方法的不同将其分为对照组(n=39)与研究组(n=42),对照组给予0.75%罗哌卡因注射液混合10%葡萄糖注射液稀释麻醉,研究组给予0.75%罗哌卡因注射液复合舒芬太尼注射液混合自身脑脊液稀释麻醉,记录手术时间、胎儿娩出所需时间、新生儿出生后5 min Apgar评分,检测两组手术前后24 h血清IL-6、肿瘤坏死因子α(TNF-α)、C-反应蛋白(CRP)水平,T细胞亚群CD3^+、CD4^+、CD8^+含量及CD4^+/CD8^+值,免疫球蛋白A(IgA)、IgG、IgM水平,并记录两组麻醉期间并发症发生情况:包括低血压、心率减慢、鼓肠。结果:研究组胎儿娩出所需时间、手术所需时间显著低于对照组(P<0.05);两组新生儿Apgar评分差异无统计学意义(P>0.05);术后,研究组血清CRP、TNF-α、IL-6水平及CD8^+含量显著低于对照组(P<0.05),研究组血清CD3^+含量、CD4^+含量、CD4^+/CD8^+值及IgA、IgG、IgM水平显著高于对照组(P<0.05),研究组总并发症发生率显著低于对照组(P<0.05)。结论:0.75%罗哌卡因注射液复合舒芬太尼注射液混合自身脑脊液稀释麻醉的方式能够减轻高龄产妇剖宫产手术中炎症反应和应激对产妇免疫功能的抑制,可作为高龄剖宫产手术麻醉的理想方案。

Objective:To investigate the influence of different anesthesia methods on immune function of senile puerpera.Methods:81 elderly non-primipara who underwent cesarean section in our hospital from December 2016 to December 2018 were retrospectively analyzed.Women were randomly divided into control group and study group according to different anesthesia methods.The control group(n=39)was given anesthesia with diluted solutions of 0.75%ropivacaine injection mixed with 10%glucose injection,while the study group(n=42)was given anesthesia with diluted solutions of 0.75%ropivacaine injection combined with sufentanil injection mixed with their own cerebrospinal fluid.Then various indexes were compared between groups,including operation duration,time for childbirth,neonatal Apgar scores in 5 min,serum inflammatory factors levels including interleukin-6(IL-6),tumor necrosis factorα(TNF-α),C-reactive protein(CRP),T cell subsets including CD3^+,CD4^+,CD8^+,CD4^+/CD8^+and immunoglobulin A(IgA),IgG,IgM levels,as well as the complications.Results:The time for childbirth and operation duration of the study group were shorter than those in control group(P<0.05).The neonatal Apgar scores showed no difference between groups(P>0.05).After operation,the study group had lower levels of CRP,TNF-α,IL-6 and CD8^+as well as higher levels of CD3^+,CD4^+,CD4^+/CD8^+,IgA,IgG and IgM than those in control group,with statistic difference(P<0.05).Conclusion:For the pregnant women with advanced maternal age,diluted solutions of 0.75%ropivacaine injection combined with sufentanil injection mixed with their own cerebrospinal fluid can be used as an ideal medication regimen for lumbar spinal anesthesia during caesarean section,which can significantly alleviate the intraoperative inflammatory reaction and stress.