硬膜外分娩镇痛对产妇血清泌乳素和新生儿神经行为的影响

Effects of epidural analgesia in labor on maternal serum prolactin and neonatal neurologic and adaptive capacity scores

目的 研究硬膜外分娩镇痛对产妇血清泌乳素(PRL)和新生儿神经行为与适应能力 (NACS)的影响。方法 66例足月、单胎头位初产妇,ASAⅠ～Ⅱ级,随机分成三组,每组22例,R 组为0.1%罗比卡因加2μg/ml芬太尼,B组为0.075%布比卡因加2μg/ml芬太尼,NL组为自然分 娩组。结果 血清PRL水平三组产妇产后24、48h较活跃早期均有明显的增高,R、B两组产妇产后 24、48h较NL组同期也有明显的增高(P<0.01),同时产后首次射乳时间R、B两组较NL组也有明 显提前(P<0.05)。三组新生儿1、5min时Apgar评分无显著性差异,但15min和2hNACS评分≥ 35分的百分率在B组明显低于NL组和R组(P<0.05)。结论 硬膜外分娩镇痛能有效缓解产痛, 促进PRL和乳汁的早期分泌。罗比卡因伍用芬太尼对NACS影响小,更适合于分娩镇痛。

Objective To determine the effects of epidural analgesia in labor on maternal serum prolactin and neonatal neurologic and adaptive capacity scores(NACS).Methods Sixty-six ASA Ⅰ-Ⅱ primipara with a full term singleton fetus in the vertex presentation were equally and randomly divided into three groups.Ropivacaine 0.1% plus fentanyl 2 μg/ml was used in group R.Bupivacaine 0.075% was given in group B instead of ropovacaine 0.1% in group R.The parturients in group NL were not given PCEA in normal labor.Results Serum prolactin at 24 and 48 hours after parturition was significantly higher than that at early active phase in all groups(P<0.01).And compared with group NL,it was also greatly increased in group R and in group B concurrently(P<0.05).The time of colostrum significantly earlier in group R and in group B than that in group NL.There was no statistical difference in 1 and 5 min Apgar scores among the three groups.The percentages of NACS ≥35 at 15 min and 2 h after parturition were significantly lower in group B than those in group NL and group R(P<0.05). Conclusions Epidural analgesia in labor can produce equivalently satisfied analgesia for labor and can increase prolactin of secretion,improve maternal colostrums and the probability of breast feeding reinforce.Ropivacaine plus fentanyl was preferable for labor epidural because of higher NACS.