病人自控硬膜外镇痛对剖宫产术后妊娠期高血压病人免疫球蛋白的影响  

Effects of patient-controlled epidural analgesia on plasma IgG,IgM and IgA levels in patients with pregnancy-induced hypertension after Cesarean section

作　　者：董有静[1] 刘杰男[1] 崔健君[1] 

机构地区：[1]中国医科大学附属第二医院麻醉科,沈阳市110004

出　　处：《中华麻醉学杂志》2006年第8期681-683,共3页Chinese Journal of Anesthesiology

基　　金：辽宁省教育厅科学技术基金(05L436)

摘　　要：目的探讨病人自控硬膜外镇痛(PCEA)对剖宫产术后妊娠期高血压病人免疫球蛋白的影响。方法择期行剖宫产术的重度妊娠期高血压病人(血压≥160/110 mm Hg),24 h尿蛋白量≥5 g)60例,年龄23～37岁,孕期37～42周,体重60～85 kg,随机分为3组(n=20)：对照组(C组)、单次硬膜外吗啡镇痛组(OTEA组)、PCEA组。麻醉均选择脊椎-硬膜外联合阻滞。PCEA组术毕保留硬膜导管,首次剂量0．125%布比卡因5 ml,安置自控镇痛泵,背景剂量0．5 ml/h,单次剂量2ml,锁定时间30 min,镇痛时间72h。OTEA组术毕硬膜外注射吗啡1．5 mg,C组术毕硬膜外注射生理盐水5ml。分别于麻醉前即刻、术后1、4、7d取母体肘静脉血5ml,采用速率散射比浊法检测IgG、IgM、IgA水平。结果与C组、OTEA组比较,PCEA组术后4、7 d IgG、IgM、IgA升高(P＜0．01)；与C组比较,OTEA组术后4d、IgM、IgA升高,术后4、7d IgG升高(P＜0．01)。结论PCEA可增强剖宫产术后妊娠期高血压病人免疫功能。Objective To investigate the effects of patient-controlled epidural analgesia （PCEA） on immunoglobulins in patients with pregnancy-induced hypertension after Cesarean section.Methods Sixty patients with pregnancy-induced hypertension （PIH） aged 23-37 yrs weighing 60-85 kg undergoing elective Cesarean section at pregnancy of 37-42 weeks were studied. Their BP was ≥ 160/110 mm Hg and 24 h urine albumin ≥ 5 g. Cesarean section was performed under combined spinal-epidural anesthesia. Epidural catheter was placed at L2.3 interspace. The patients were randomly divided into 3 groups （n = 20 each ）： group Ⅰ received PCEA with 0. 125 % bupivacaine （loading dose 5 ml, bolus dose 2 ml, lockout interval 30 rain, background infusion 0.5 ml· h^-1 ） ; group Ⅱ received epidural morphine 1.5 mg in 5 ml of normal saline at the end of operation and group Ⅲ received epidural normal saline 5 ml （control） . Venous blood samples were taken immediately before Cesarean section （baseline） and on the 1 st, 4th and 7th day after operation for determination of plasma IgG, IgM and IgA levels. Results The three groups were comparable with respect to age, body weight, weeks of pregnancy, duration of operation and the amount of fluid infused during operation. There was no significant difference in plasma IgG, IgM and IgA levels among the 3 groups before and on the 1st day after operation. The plasma IgG, IgM and IgA levels were significantly higher in PCEA group than in group Ⅱ and Ⅲ on the 4th and 7th day after operation. The plasma IgG, IgM and IgA levels on the 4th day and IgG level on the 7th day were significantly higher in group Ⅱ than in group Ⅲ. Conclusion PCEA can improve the immune function of the patients with PIH after Cesarean section.

关 键 词：免疫球蛋白类 镇痛 病人控制 镇痛 产科 高血压 妊娠性 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]