吗啡硬膜外病人自控镇痛对剖宫产术后母乳喂养新生儿神经和适应能力的影响

Effect of patient-controlled epidural analgesia with morphine on breast-feeding neonatal neurological and adaptive capacity in parturients after cesarean section

目的 观察剖宫产术后应用吗啡硬膜外病人自控镇痛对母乳喂养新生儿生理状况的影响。方法 随机选择拟行剖宫产术的产妇(试验组)和正常分娩产妇各30例(对照组)。试验组采用连续硬膜外麻醉,术后以吗啡经硬膜外导管持续泵注行术后镇痛。对照组不用任何阿片类药物。分别于术后2、4、8、12、24 h应用高效液相色谱法检测产妇静脉血及乳汁中吗啡浓度。同时对两组新生儿行神经和适应能力评分。结果 试验组产妇镇痛效果满意,产妇血浆及乳汁中吗啡浓度均随时间延长而下降,产妇血浆中吗啡浓度与乳汁中吗啡浓度有良好的相关性(r=0.9998,P<0.05)。两组新生儿在各时点的神经和适应能力评分值均大于35分,两组间比较差异无显著性(P>0.05)。结论 吗啡行术后硬膜外病人自控镇痛对母乳喂养的新生儿精神、行为无明显不良影响,可安全应用于临床。

Objective To evaluate patient-controlled epidural analgesia (PCEA) with morphine on breastfeeding neonatal neurological arid adaptive capacity after cesarean section.Methods Thirty healthy parturients after cesarean section under epidural block were randomly selected as test group, and thirty healthy parturients with natural childbirth served as control group without any opioids administration. In test group the patients received PCEA after cesarean section. The regimen included a loading dose of morphine 2mg, bupivacaine 12.5mg and droperidol 0.5mg in 10ml of normal saline, followed by background infusion at 2 ml·h^(-1) with an 2ml bolus dose and a 20min lockout interval. The PCEA solution contained morphine 20mg, bupivacaine 125mg and dreporidol 5 mg in 100ml of normal saline. The samples of intravenous blood and colostrums were taken 2, 4, 8,12 and 24 h after the loading dose administration for measurement of plasma and colostrums concentrations of morphine. The neonatal neurological and adaptive capacity scores(NACS) of both groups were recorded at corresponding time points, Results Concentrations of morphine in colostrum and plasma kept decreasing following the loading dose administration. There was a significant positive correlation between concentrations of morphine in colostrum and plasma (r=0.998, P<0.01). Neonatal NACS in both groups were similar with all higher than 35.Conclusion The PCEA with morphine mentioned above can be safe for neonates in parturients after cesarean section.