盐酸罗哌卡因椎管内麻醉用于合并HIV感染产妇剖宫产术的效果及对细胞免疫功能的影响

Effect of ropivacaine hydrochloride intraspinal anesthesia on cesarean section for women with HIV infection and its influence on cellular immune function

目的分析盐酸罗哌卡因椎管内麻醉用于合并人类免疫缺陷病毒(HIV)感染产妇剖宫产术的效果及对细胞免疫功能的影响。方法抽取2017年5月至2021年6月郑州市第六人民医院行剖宫产术的HIV产妇72例,按随机数字表法分为研究组与对照组,每组36例。对照组采用单纯硬膜外麻醉,研究组采用腰硬联合麻醉。比较两组麻醉效果分级、麻醉相关时间、血流动力学指标[平均动脉压(MAP)、心率(HP)]、细胞免疫功能(T淋巴细胞亚群CD3^(+)、CD4^(+))、不良反应发生率和新生儿Apgar评分。结果研究组麻醉效果分级优于对照组(P<0.05);与对照组比较,研究组麻醉显效时间、麻醉完善时间、麻醉恢复时间较短(P<0.05);麻醉后5 min(T2)、切皮时(T3)、术毕即刻(T4),研究组MAP、HR较对照组低(P<0.05);术前、术后24 h,两组CD3^(+)、CD4^(+)水平比较差异未见统计学意义(P>0.05);研究组不良反应发生率为8.33%(3/36),与对照组5.56%(2/36)比较,差异未见统计学意义(P>0.05);两组1 min、5 min Apgar评分比较差异未见统计学意义(P>0.05)。结论盐酸罗哌卡因椎管内麻醉应用于HIV感染产妇,腰硬联合麻醉和单纯硬膜外麻醉均不会对产妇免疫功能、新生儿情况产生较大影响,但腰硬联合麻醉方案能获得更理想的麻醉效果,减轻对产妇血流动力学的影响,且具有安全性。

Objective To analyze the effect of ropivacaine hydrochloride intraspinal anesthesia on cesarean section for women with human immunodeficiency virus(HIV)infection and its influence on cellular immune function.Methods A total of 72 HIV-positive pregnant women who underwent cesarean section in Zhengzhou Sixth People’s Hospital from May 2017 to June 2021 were selected and divided into study group and control group according to random number table method,with 36 cases in each group.The control group was treated with simple epidural anesthesia,and the study group was treated with combined spinal-epidural anesthesia.The classification of anesthesia effect and anesthesia related time,hemodynamic indexes including mean arterial pressure(MAP)and heart rate(HP),cellular immune function assessed by T lymphocyte subsets cluster of differentiation 3^(+)(CD3^(+))and cluster of differentiation 4^(+)(CD4^(+)),incidence of adverse reactions and neonatal Apgar score were compared between the two groups.Results The classification of anesthetic effect in the study group was better than that in the control group(P<0.05).Compared with the control group,the onset time improvement time and recovery time of anesthesia in the study group were shorter(P<0.05).MAP and HR in the study group were lower than those in the control group at 5 min after anesthesia(T2),at the time of skin incision(T3),and immediately after operation(T4)(P<0.05).There was no significant difference in the levels of CD3^(+)and CD4^(+)between the two groups before and 24 hours after operation(P>0.05).The incidence of adverse reactions in the study group was 8.33%(3/36),which had no statistically significant difference with 5.56%(2/36)in the control group(P>0.05).There was no significant difference in the Apgar score at 1 min and 5 min after birth between the two groups(P>0.05).Conclusions Ropivacaine hydrochloride intraspinal anesthesia for HIV-positive pregnant women,combined with spinal-epidural anesthesia or simple epidural anesthesia,will not have a great impact on immune function and neonatal situation;but combination of it with spinal-epidural anesthesia scheme can achieve more ideal anesthesia effect and reduce the impact on hemodynamics,with great safety.