摘要目的 通过观察腰-硬联合阻滞(combined spinal-epidural analgesia,CSEA)分娩镇痛过程中母血白细胞介素(IL)-β、IL-10及T细胞亚群的变化,探讨镇痛对母体免疫功能及Th1/Th2型细胞因子平衡的影响.方法 50例足月产妇随机分为镇痛组(Ⅰ组)和自然分娩组(Ⅱ组),每组各25例.Ⅰ组行分娩镇痛,腰麻用药为20μg芬太尼,硬膜外用药为0.1%罗哌卡因复合0.000 2%芬太尼.两组产妇在宫口开大2 cm-3 cm(T1),胎儿娩出时(T2)、分娩后24 h(T3)采血3 ml,用流式细胞仪法检测T细胞亚群(CD3+、CD4+,CD8+、CD4+/CD8+),放射免疫法检测皮质醇、IL-1β,ELISA法检测IL-10.记录产程、新生儿Apgar评分以及疼痛视觉模拟评分(VAS).按入选标准选取25例无宫缩待产妇为对照组(C组).结果 Ⅰ组第一产程活跃期比Ⅱ组明显缩短(P＜0.05),新生儿Apgar评分组间无统计学差异.伴随产程,两组母血IL-β浓度明显增加(P＜0.05),T2时点Ⅰ组皮质醇、IL-1β、IL-10明显低于Ⅱ组(P＜0.05).两组母血CD3+、CD4+,CD4+/CD8+均有不同程度降低,在T3时点降低显著(P＜0.05),且Ⅱ组明显低于Ⅰ组(P＜0.05).结论 CSEA分娩镇痛可缩短第一产程活跃期,有效地减轻疼痛等应激反应对产妇免疫功能的抑制,有利于维持Th1/Th2型细胞因子平衡.

abstractsObjective To investigate the effect of combined spinal-epidural analgesia(CSEA) on immunological function and Th1/Th2 balance by observing the levels of serum T-lymphocyte subsets,IL-1β and IL-10 during labor in maternity.Methods Fifty healthy primipara expecting spontaneous labor were randomly divided into two groups(n=25).CSEA was performed with 20 μg fentanyl for lumbar analgesia and with complex of ropivacaine(0.1%) and fentanyl(2 μg/ml) for epidural analgesia in group Ⅰ,and no labor analgesia was given in group Ⅱ.Serum cortisol,IL-1β,IL-10 and T lymphocyte subsets was detected at cervical dilation of 2 cm-3 cm (T1),fetal disengagement (T2) and 24 h after childbirth (T3).Labor progress,VAS and neonatal Apgar score were recorded.Results The active phase of the first labor stage significantly shortened in group Ⅰ compared to that in group Ⅱ (P＜0.05),without difference in neonatal Apgar score between two groups.Along with labor progress,the level of serum IL-1β markedly increased in two groups,and the levels of cortisol,IL-1β and IL-10 were obviously decreased at T2 in group Ⅰ compared to those in group Ⅱ(P＜0.05).The levels of serum CD3+,CD4+,and CD4+/CD8+ decreased in both groups,with significant reduction at T3 (P＜0.05) and more significant in group Ⅱ than in group Ⅰ (P＜0.05).Conclusion CSEA shortens the active delivery phase in the first stage of labor and alleviates pain stress-induced inhibition on immune function and may benefit the balance of Th1/Th2 in maternity.