The Influence Of Combined Spinal-Epidural Analgesia On T Lymphocyte Subsets And Th1/Th2 Type Cytokine Balance Of Maternity

Objective : This study was designed to investigate the effect of combined spinal-epidural analgesia(CSEA) on immunological function and Th1/Th2 type cytokines balance by observing change in the level of the T-lymphocyte subsets and IL-1βand IL-10 in maternity serum in labor.Methode: Fifty healthy primipara with single birth, vertex present and ASA I between July 2007 and Dec 2007 in the first Affiliated Hospital of Nangchang University School of Medicine who were in spontaneous labor were randomly divided into two subgroups when their cervical dilations were in 2-3cm. In interfering subgroup(n=25), the puncture point of CSEA is at L3-4 interspace, the fentanyl(20μg) was used in lumbar anesthesia, the ropivacaine(0.1%) combined with fentanyl (1μg/ml) was used in epidural analgesia. Blood samples were taken from the mother vein at cervical dilation in 2-3m (T1), fetal disengagement(T2), 24hrs after childbirth (T3). The serum separated from the coagulated blood were stored at -70℃until thawed for cortisol(CORT), IL-1βand IL-10 assay. The flow cytometer method was used to measure T lymphocyte subsets, the radioimmunoassay(RIA) method was uaed to measure CORT and IL-1β, the enzyme linked immunosorbent assay(ELISA) was used to measure IL-10. In addition, Data on labor progress,VAS score and neonatal Apgar score were recorded for each patient. According to selecting standards, the anodinia puerpera(n=25) were controled.Results: (1) In the CSEA group, the active phase in the first stage of labor after analgesia were significantly lower than that in spontaneous delivery group ( P<0.05); There was no difference in the second stage, the third stage and the neonatal Apgar score between the two groups( P>0.05). (2) The level of the CORT in maternity serum of the interfering subgroup were markedly lower than that of the non-interfering one(P<0.05). (3) With the progress of labor, the level of the IL-1βmarkly increased in two groups, moreover, at T2, that of the interfering one were significantly lower, followed by that of the non-interfering one(P<0.01). (4) At T2, in the interfering one, the level of the IL-10 were obviously lower than that in the non-interfering one. (4) In two groups, the levels of the CD3~+,CD4~+,CD4~+/CD8~+ degraded in different degree and significantly decreased at T3 (P<0.05), and that of non-interfering one were obviously lower than that of interfering one(P<0.05).Conclusions:CSEA could shorten the active delivery phase in the first stage of labor, and has no effect on the neonatal Apgar score. It can alleviate the inhibitive effect on immune function cause by pain stress response, which may be a better method to maintain appropriate balance for Th1/Th2 type cytokines.