- 學位論文
全身麻醉與半身麻醉對免疫系統抑制效應的比較：以剖腹產產婦一年內發生帶狀皰疹為例
Effect of General and Regional Anesthesia on Immunity: Women had Herpes Zoster after Caesarean Section in One Year Period
摘要
2006年我國婦女因生產而住院者為198,334人次，是我國女性最常見的住院原因，其中，高達33.54%的產婦選擇剖腹生產，剖腹產手術已成為婦女最常施行的手術。台灣剖腹產率根據行政院衛生署2010年公布的統計數據，自民國90年至99年第一季都高於30%，自民國92年起更有逐年增加的趨勢，從32.81%升至38.20%；在國際間剖腹產率也呈現上升的趨勢。由此可知各國剖腹產人數都在上升，高剖腹產率所引發婦女健康議題值得我們深入探討。 隨著醫療技術進步，目前剖腹產所使用的麻醉方法一般可分成全身麻醉(General Anesthesia)和半身麻醉(Regional anesthesia)兩種，剖腹產後止痛控制相當完善，促使許多產婦由於害怕自然生產的陣痛因而選擇剖腹生產。近年來剖腹產使用半身麻醉較為醫師及產婦所接受的麻醉方式。因此剖腹生產人數在台灣越來越多，影響人數也越來越多。 剖腹產必須接受麻醉才可進行，然而研究顯示細胞免疫性在手術和麻醉過後會產生變化，這組織損傷明顯降低了免疫系統的能力；其中剖產所使用的全身麻醉被認為會強烈影響免疫系統，近年來多項研究與文獻顯示全身麻醉比半身麻醉引起較多的副作用與疾病再發率，如癌症手術後癌症再復發。因此本研究使用當免疫系統降低時會發生的帶狀皰疹做為產後免疫系統變化的現象，用台灣全民健保資料庫進行歸人分析，比較使用全身麻醉與半身麻醉產後一年內產生帶狀皰診風險。 本研究結果顯示使用不同麻醉方式對產生帶狀皰疹有顯著差異，且剖腹產使用全身麻醉的產婦生產後追蹤其一年內有無診斷出帶狀皰疹，控制其他變項後分析結果，其風險為使用半身麻醉的產婦的1.286倍，小於20歲者剖腹產一年內產生帶狀皰疹的風險比25-29歲高0.674倍，20-24歲者剖腹產後一年內產生帶狀皰疹的風險是25-29歲組距之產婦的0.891倍，30-34歲者剖腹產後一年內產生帶狀皰疹的風險比25-29歲高1.101倍，大於34歲者的風險更高於25-29歲者1.456倍並有顯著差異，由勝算比來看，年齡越大，和對照組比發生帶狀皰疹的風險就越大。當產婦為緊急剖腹產時，剖腹產後一年內產生帶狀皰疹的風險為不是緊急剖腹產的1.794倍，若未控制其他變項時，是緊急剖腹產的產婦生產後一年內產生帶狀皰疹的風險比為不是緊急剖腹產的產婦的2.142倍，為本次研究所有變項中風險最高的。生產為第四胎以上者產生帶狀皰疹的風險明顯比三胎以下者高，產婦生產四胎以上者的風險是最高的。
並列摘要
Objective: In 2006 Taiwan there are 198,334 women were hospitalized because had delivery, which is the most common cause of admission. Up to 33.54% of mothers choose caesarean section. Caesarean section has become the most common implementation of women’s surgery. Anesthetic practice for caesarean section has changed during the last decades. There is a world-wide shift in obstetric anesthetic practice in favour of regional anesthesia. Herpes zoster carries considerable morbidity and substantial health care provider cost. Depressed cell-mediated immunity, increased age, illness, and immunosuppressive therapies increase the risk of HZ. In this study we analyzed the related and the risk of the management of anesthesia of caesarean section in one tear period after delivery. Method: This study used two nationwide population-based datasets. The first dataset was Taiwan birth certificate registry published by Department of Internal Affairs, Taiwan. The Pregnant women who had caesarean section under anesthesia and patients with confirmed cases of herpes zoster were included in the study. SAS 9.2 was used to perform statistical analyses in this study. Logistic regressions were carried out to compute the adjusted one-year herpes zoster-free survival rates between these two groups. We present hazard ratios (HR) along with the 95% confidence intervals (CI). A two-tailed value of P < 0.05 was used to determine statistical significance. Results: We found that of the 162,495 sampled women, 572 women (0.35%) had herpes zoster during the one-year follow-up period, including 98 from women receiving general anesthesia and the other 474 from women receiving regional anesthesia. Compared to women receiving regional anesthesia, women receiving general anesthesia were more likely to be older (mean age=29.8 vs. 29.3 years, p<0.001), be unmarried (p<0.001), were premature (p<0.001), the panity (p<0.001), and were more likely to undergo emergent CS (p<0.001). Hazard of herpes zoster during the one-year follow-up period was 1.286 (95% CI = 1.028-1.608, p=0.028) times greater for women receiving general anesthesia than for women receiving regional anesthesia after adjusting for maternal age, marital status, emergent CS and infant’s sex, premature and parity. Interestingly, we also found that those women receiving emergent CS were 1.794 times more likely to have herpes zoster than those who did not.
參考文獻
延伸閱讀
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