PCEA联合硬膜外间歇脉冲输注镇痛对分娩产妇T淋巴细胞亚群及运动功能的影响

doi:10.3969/j.issn.10073205.2019.07.017

河北医科大学学报

PCEA联合硬膜外间歇脉冲输注镇痛对分娩产妇T淋巴细胞亚群及运动功能的影响

1.河北省保定市妇幼保健院西院妇产科，河北保定 071000；2.河北省定兴县医院妇产科,河北定兴072650；
3.河北省保定市妇幼保健院西院麻醉科,河北保定 071000；4.民航总医院神经内科,北京 100123

出版日期:2019-07-25 发布日期:2019-07-16
作者简介:张晶（1984-），女，河北保定人，河北省保定市妇幼保健院主治医师，医学硕士，从事妇产科疾病诊治研究。

The effect of PCEA combined with intermittent epidural bolus analgesia on T lymphocyte subsets and motor functions in pregnant women#br#

1.Department of Gynaecology and Obstetrics， Western hospital of Baoding Maternal and Child Health
Hospital， Hebei Province， Baoding 071000， China；2.Department of Gynaecology and Obstetrics，
Dingxing County Hospital， Hebei Province， Dingxing 072650，China； 3.Department of
Anesthesiology， Western Hospital of Baoding Maternal and Child Health Hospital，
Hebei Province, Baoding 071000，China； 4.Department of Neurology，
the Civil Aviation General Hospital， Beijing 100123， China

Online:2019-07-25 Published:2019-07-16

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗探讨硬膜外腔给药途径病人自控镇痛（patient control epidural analgesia，PCEA）联合硬膜外间歇脉冲输注（intermittent epidural bolus，IEB）镇痛对分娩产妇T淋巴细胞亚群及运动功能的影响。
〖HTH〗方法〖HTSS〗〖KG*2〗选择足月高龄产妇140例，根据随机数字表法分为观察组（n=70例）和对照组（n=70例）。对照组采用PCEA联合持续背景输注（continuous epidural infusion，CEI）麻醉，观察组采用PCEA联合IEB麻醉，比较2组的镇痛效果、产妇术中及术后手术情况指标、运动阻滞情况及麻醉前后T淋巴细胞亚群和炎性因子水平。
〖HTH〗结果〖HTSS〗〖KG*2〗2组视觉模拟评分法(Visual Analogue Scale，VAS)评分均呈先降低后升高趋势，观察组VAS评分显著低于对照组，其组间、时点间，组间·时点间交互作用差异有统计学意义（P＜005）。观察组PCEA追加例数、罗哌卡因用量、舒芬太尼用量、剖宫产例数少于或小于对照组，产妇满意度高于对照组（P＜005）。观察组运动阻滞发生率显著少于对照组（P＜005），2组第一产程时间、第二产程时间、第三产程时间、镇痛时间、子宫收缩间隔时间、子宫收缩持续时间、胎心率、使用催产素例数、产妇不良反应例数、新生儿出生1min和5 min Apgar评分差异均无统计学意义（P＞005）。2组CD3+、CD4+、CD4+/CD8+均呈降低趋势，白细胞介素6（interleukin6,IL6)、肿瘤坏死因子α（tumor necrosis factorα,TNFα)均呈升高趋势，观察组CD3+、CD4+、CD4+/CD8+高于对照组，IL6、TNFα低于对照组，其组间、时点间、组间·时点间交互作用差异有统计学意义（P＜005）；2组CD8+组间、时点间、组间·时点间交互作用差异无统计学意义（P＞005）。
〖HTH〗结论〖HTSS〗〖KG*2〗PCEA联合IEB对高龄分娩产妇镇痛效果显著，且麻醉药物用量少，患者满意度高，有助于减少剖宫产率和运动阻滞的发生，同时可改善免疫抑制及炎症反应，值得推广应用。

关键词: 分娩, 镇痛, T淋巴细胞亚群, 运动功能

Abstract: ［Abstract］〓Objective〖HTSS〗〓To explore the effect of patient control epidural analgesia(PCEA) combined with intermittent epidural bolus(IEB) analgesia on T lymphocyte subsets and motor functions in pregnant women.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 140 cases of fullterm advanced maternal age were selected. According to the random number table method, they were divided into observation group(n=70) and control group(n=70). The control group was anesthetized with PCEA combined with continuous epidural infusion(CEI), the observation group was anesthetized with PCEA combined with IEB. Compared the analgesic effects, indexes of intraoperative and postoperative operation in parturient, motion block, T lymphocyte subsets and inflammatory factor levels before and after anesthesia in both groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The Visual Analogue Scale(VAS) scores of both groups decreased first and then increased. The VAS score of the observation group was significantly lower than that of the control group, the difference of interblock, time points and interblock·time points was statistically significant（P＜005）. The number of PCEA addition, the dosage of ropivacaine, sufentanil and caesarean section cases in the observation group were less than those in the control group, and the maternal satisfaction in the observation group was higher than that of the control group（P＜005）. The incidence of motor block in the observation group was significantly lower than that in the control group(P＜005). There was no significant difference between the two groups on the first, second and thirdstage of labor time, analgesic time, interval and duration timeofuterine contraction, fetal heart rate, the number of patients using oxytocin，pregnant women adverse reactions, neonate Apgar scores 1 and 5 minutes after birth（P＞005）. The levels of CD3+, CD4+, CD4+/CD8+, interleukin 6(IL6) and tumor necrosis factor α(TNFα) had the trend of decrease in both groups. The CD3+, CD4+ and CD4+/CD8+ of the observation group were higher than those of the control group, and IL6 and TNFα were lower than those of the control group, the difference of interblock, time points and interblock·time points was statistically significant（P＜005）. The difference of interblock, time points and interblock·time points on CD8+ in the two groups was not statistically significant（P＞005）.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The analgesic effect of PCEA combined with IEB on aged parturient was significant, the dosage of anesthetic was less, the patient satisfaction was high, it can reduce the rate of cesarean section and the occurrence of motor block, and improve the immune suppression and inflammation, which is worth popularizing.

Key words: parturition； analgesia； Tlymphocyte subsets, motor function

张〓晶1，薛〓宁1，李胜男2，王秀芳1，陈江红3，杨珊珊4. PCEA联合硬膜外间歇脉冲输注镇痛对分娩产妇T淋巴细胞亚群及运动功能的影响[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2019.07.017.

ZHANG Jing1， XUE Ning1， LI Shengnan2， WANG Xiufang1， CHEN Jianghong3， YANG Shanshan4. The effect of PCEA combined with intermittent epidural bolus analgesia on T lymphocyte subsets and motor functions in pregnant women#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2019.07.017.

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PCEA联合硬膜外间歇脉冲输注镇痛对分娩产妇T淋巴细胞亚群及运动功能的影响

The effect of PCEA combined with intermittent epidural bolus analgesia on T lymphocyte subsets and motor functions in pregnant women#br#

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