分娩镇痛注射方式对产妇血清IL—6、TNF—α及T淋巴细胞亚群水平的影响

阳平贵　吴怀勇　吴俊英

[摘 要] 目的：探讨不同分娩镇痛方式对产妇血清IL-6、TNF-α及T淋巴细胞亚群水平的影响。方法：选择2015年5月至2016年1月拟在我院妇产科住院并需要进行分娩的正常产妇120 例，按照随机数字表方法分为观察组（A组）和对照组（B组），各60例。两组患者均采用硬膜外阻滞麻醉进行分娩镇痛，其中A组产妇采用脉冲式注射给药方式；B组采用给予持续恒定的注射给药方式。观察两组产妇围术期生命体征的变化，分别于宫口开至 2～3cm（T1）、镇痛开始后30min（T2）、胎儿分娩时（T3）对两组患者进行疼痛评分（VAS）；记录两组产妇产程时长（第一产程活跃期、第二产程、第三产程）及药物总量，统计两组产妇分娩方式（剖宫产、顺产、阴道助产）以及产后出血、新生儿窒息等结局；并分别于T1、T3及分娩后 24 h（T4）进行IL-6、TNF-α及T淋巴细胞亚群检测。结果：两组产妇一般情况、产程、分娩方式，产后出血以及新生儿窒息情况相比差异无统计学意义；T2，T3时刻A组产妇VAS评分明显低于B组且A组产妇术中罗哌卡因和舒芬太尼的总用药量也明显低于B组，P<0.05；B组T4时刻CD3+、CD4+、CD4+/CD8+显著低于A组，B组T3、T4时刻IL-6、TNF-α显著高于A组，差异有统计学意义。结论：脉冲式分娩镇痛注射方式能够有效降低产妇分娩期的疼痛、减少用药量而且能够减轻炎症反应和应激对产妇免疫功能的抑制。

[关键词] 分娩镇痛；IL-6；TNF-α；T淋巴细胞

中图分类号：R614 文献标识码：B 文章编号：2095-5200（2016）06-063-04

DOI：10.11876/mimt201606024

Effects of injection method for labor analgesia on maternal serum levels of IL-6， TNF-αand T lymphocyte subsets YANG Pinggui1，WU Huaiyong2，WU Junying3. （1.Department of Anesthesiology，Chenghua People，s Hospital，Chengdu 610051 China；2. Department of paediatrics， Chenghua People，s Hospital，Chengdu 610051 China；3. Department of gynaecology and obstetrics， Chenghua People，s Hospital，Chengdu 610051 China）

[Abstract] Objective： This study was designed to investigate the effects of different methods of labor analgesia on the levels of IL-6， TNF-αand T lymphocyte subsets in maternal serum. Methods： 120 normal puerperae hospitalized in department of obstetrics and gynecology of our hospital from May 2015 to January 2016 were selected for the study， and divided into observation group （group A） and control group （group B） according to the random number table method， each 60 cases. Two groups of patients were used epidural block anesthesia for labor analgesia， group A was applied the mode of pulse-injection drug delivery； group B was used the method of constant-injection drug delivery. The changes of vital signs were observed in the two groups during the perioperative period， visual analog pain scores （VAS） were graded in the two groups of patients as the cervix opened 2-3 cm （T1）， 30 min after the start of analgesia （T2）， and at fetal childbirth （T3）； maternal duration of labor （active phase of the first stage of labor， the second stage of labor， the third stage of labor） and total drug amount were recorded， delivery modes of two groups of puerperae （cesarean section， vaginal delivery， miniforceps delivery）， postpartum hemorrhage， neonatal asphyxia and other outcomes were stastically analyzed； and IL-6， TNF- alpha and T lymphocyte subsets were measured at T1， T3 and 24 h after birth （T4）， rerespectively. Results： The general materias，stages of labor， modes of delivery， postpartum hemorrhage and neonatal asphyxia in two groups had no significant difference； VAS scores at the time point of T2， T3 in group A were significantly lower than in group B， and the total dosage of ropivacaine and sufentanil during delivery in group A was significantly lower than in group B （P<0.05）； CD3+， CD4+， and CD4+/CD8+ at the time point of T4 in group B were significantly lower than in group A， IL-6， TNF-a at the time points of T3 and T4 in B group were significantly higher than in group A， the differences were statistically significant. Conclusions： Pulse delivery analgesia injection can effectively reduce the pain of delivery， reduce the use of drugs and reduce the inflammatory reaction and stress on inhibition of maternal immune function.

[Key words] labor analgesia； IL-6； TNF-α； T lymphocyte

分娩时产妇的剧烈疼痛、焦虑、紧张等不仅可以引起产妇的全身应激反应而且持续严重疼痛和相应的应激反应也可引起产妇呼吸、循环及其他生理功能的明显改变，并对胎儿及新生儿产生负面影响[1]。随着医学模式的转变和人们生活质量的提高， 越来越多的产妇不能忍受剧烈产痛，分娩镇痛的应用也日益广泛，打破了“分娩必痛”的传统观念。……