术前肌肉注射地塞米松对剖宫产产妇机体免疫力及炎症反应水平影响分析  

Effect of intramuscular injection of dexamethasone on the maternal immunity and inflammatory response in cesarean section

作　　者：李培峰 郝炳锋 Li Peifeng;Hao Bingfeng(Deputy Chief Pharmacist,Zhidan County Maternal And Child Health Hospital,Shaanxi 717500,China)

机构地区：[1]陕西省志丹县妇幼保健院药剂科,717500 [2]志丹县药品配送中心

出　　处：《山西医药杂志》2018年第16期1882-1885,共4页Shanxi Medical Journal

摘　　要：目的探讨剖宫产产妇麻醉前肌肉注射地塞米松对产妇机体免疫力及炎症反应水平的影响。方法将142例符合剖宫产手术指征的足月产妇均分为2组,2组均采用腰硬联合麻醉。对照组于麻醉前输注4μg/mL的氢吗啡酮;而观察组则肌肉注射0.5mg/kg地塞米松磷酸钠注射液用于术后镇痛。测量2组术前24h、术后24h、72h外周血T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、免疫球蛋白(IgA、IgG、IgM)、补体(C3、C4)及血清炎症因子[C反应蛋白(CRP)、白细胞介素(IL)-6及肿瘤坏死因子(TNF-α)]水平,并进行统计学分析。结果 2组术前、术后24h、72h外周血T细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+,免疫球蛋白IgA、IgG、IgM,补体C3、C4及血清炎症因子CRP、IL-6及TNF-α水平间差异均有统计学意义(P<0.05)。其中术后24h,2组T细胞亚群CD3+、CD4+、CD4+/CD8+值、IgA、IgG、IgM、C3、C4水平明显下降,CD8+含量、CRP、IL-6及TNF-α水平均明显升高(P<0.05);而术后72h时2组CD3+、CD4+、CD4+/CD8+值、IgA、IgG、IgM、C3、C4水平明显升高,CD8+的含量、CRP、IL-6及TNF-α水平均明显下降(P<0.05),且上述指标均明显优于术前24h(P<0.05)。与手术前24h比,2组72hCD3+、CD4+、CD4+/CD8+值、IgA、IgG、IgM、C3、C4水平明显升高,CD8+、CRP、IL-6及TNF-α水平明显下降,且与同时期对照组相比,观察组术各指标变化更显著(P<0.05)。结论剖宫术前肌肉注射一定剂量地塞米松磷酸注射液可有效缓解麻醉药物对产妇机体产生的免疫抑制作用,抑制机体炎症因子释放,促进免疫功能恢复,有助于患者预后。Objective To investigate the effect of intramuscular injection of dexamethasone on maternal immunity and inflammatory response before cesarean delivery.Methods One hundred and forty-two full-term maternal patients who met the indications for cesarean section were divided into two groups.Both groups were treated with combined spinal epidural anesthesia.Control group was infused with 4μg/mL hydromorphone before anesthesia,and in the observation group,0.5 mg/kg dexamethasone sodium phosphate injection was used for postoperative analgesia.The levels of peripheral blood T lymphocyte subsets（CD3＋,CD4＋,CD8＋,CD4＋/CD8＋）,immunoglobulins（IgA,IgG,IgM）,complement（C3,C4）,and serum inflammatory factors（CRP,IL-6 and TNF-α）were measured 24 hbefore surgery,24 h,and 72 hafter surgery in two groups,and were analyzed statistically.Results Preoperative and postoperative 24 hand 72 h,the levers of peripheral blood T lymphocyte subsets CD3＋,CD4＋,CD8＋,CD4＋/CD8＋,immunoglobulin IgA,IgG,IgM,complement C3,C4,and serum inflammatory factors CRP,IL-6,TNF-αwere analyzed by Univariate analysis of variance of two groups,and the differences were significant（P〈0.05）.At 24 hours after operation,the levels of CD3＋,CD4＋,CD4＋/CD8＋,IgA,IgG,IgM,C3,and C4 levels in the two groups decreased significantly,and the levels of CD8＋,CRP,IL-6 and TNF-αwere significantly increased（P〈0.05）.At 72 hours after operation,the levels of CD3＋,CD4＋,CD4＋/CD8＋,IgA,IgG,IgM,C3,and C4 were significantly increased in the two groups,and the levels of CD8＋,CRP,IL-6,and TNF-were significantly decreased（P〈0.05）.And the above indicators were significantly better than those preoperative 24 h（P〈0.05）.Compared with 24 hbefore surgery,the levels of CD3＋,CD4＋,CD4＋/CD8＋,IgA,IgG,IgM,C3 and C4 were significantly increased in the two groups at 72 hours. The levels of CD8＋,CRP,IL-6,and TNF-αwere significantly decreased（P〈0.05）.Compared with the control group at the same time,the changes of each

关 键 词：剖宫产术 地塞米松 免疫 炎症趋化因子类 

分 类 号：R719.8[医药卫生—妇产科学]